Lipedema and lymphedema are both associated with protein-rich water retention in the subcutaneous tissue of the extremities, but they have very different pathogenesis. It is usually possible to distinguish between them clinically, but diagnostically they can be difficult. Unfortunately, this often leads to incorrect or missing diagnoses in practice. The consequence: if the treatment is not effective or if there is a lack of therapy, the individual clinical course of the disease is not known.
This article will give you an overview of the difference between lipedema, lipolymphedema and lymphedema. Enjoy reading!
Lipedema is a circumscribed, symmetrically localized increase in subcutaneous fat in the lower extremities. In about one third of cases, the arms are also affected. This results in a disproportion between the trunk and the extremities. It occurs exclusively in women and usually begins with puberty, but also after taking hormones, pregnancy or menopause. The course of the disease is always chronic, although it is not predictable in individual cases. It is characterized by increased tenderness and spontaneous pain. Pain symptoms may be absent at the onset of the disease and may not develop for years. In later stages, lymphedema may develop, which is then called lipolymphedema. In up to 70% of cases, there is a female family member with lipolymphedema. This suggests a genetic predisposition. Otherwise, the cause is unknown. You can read more about lipedema in this magazine article: Link to the magazine category Lipedema.
Depending on the severity of the findings, a secondary lymphatic drainage disorder may occur in the course of lipedema. Lipolymphedema is the presence of lipedema with a compromised lymphatic drainage system. Although in the early stages of lipedema lymphatic drainage is actually increased and there is no lymphatic obstruction, in later stages the capacity of the lymphatic system may be exhausted and the volumes cannot be handled. This results in high-volume insufficiency, i.e. the thickness of the skin and subcutis increases as the disease progresses. Over the years, fibrosis of the tissue with lymphangiosclerosis and perilymphovascular fibrosis may occur. This leads to a decrease in transport capacity. If the lymphatic system decompensates, the picture of lipolymphedema develops up to dermatoliposclerosis.
Lymphedema is a chronic inflammatory disease of the interstitium resulting from primary (congenital) or secondary (acquired) damage to the lymphatic drainage system. This results in mechanical insufficiency of the lymphatic system due to a reduction in transport capacity: the lymphatic system is unable to cope with the lymphatic load, resulting in a pathologically visible increase in fluid, primarily in the subcutaneous interstitial connective tissue - the edema. Unlike lipedema, lymphedema is classified in four stages, not three. High-resolution ultrasound can be used to detect edema, but does not provide information about its cause. A CT or MRI scan may be used to confirm the diagnosis. Lipedema is a thickening of the skin and subcutaneous tissue. Unlike lymphedema, there is no "honeycomb" structure of the subcutis and no accumulation of edema.
One of the main criteria for comparing the two conditions is that lipedema leaves the hands and feet free of swelling and thickening. Similarly, lymphedema can occur in the trunk and may not be symmetrical. For an overview, see the table below:
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