Hypothesis and evolution in the current treatment of lipedema syndrome
José Maria Pereira de Godoya king 
, Maria de Fatima Guerrero GodoyBC
oneDepartment of Cardiology and Cardiovascular Surgery, Faculty of Medicine of São José do Rio Preto (FAMERP), CNPq (National Research and Development Council), São José do Rio Preto 15020-010, Brazil
bPostgrado Stricto Sensu, Faculty of Medicine of Sao Jose do Rio Preto (FAMERP), Sao Jose do Rio Preto, Brazil
CResearch Group of the Godoy Clinic, Sao Jose do Rio Preto, Brazil
dCorresponding author: José Maria Pereira de Godoy, Department of Cardiology and Cardiovascular Surgery, Faculty of Medicine of São José do Rio Preto (FAMERP), CNPq (National Council for Research and Development), São José do Rio Preto, Brazil
Manuscript submitted January 13, 2022, accepted January 20, 2022, published online February 24, 2022
Short title: Current treatment of lipedema syndrome
doi: https://doi.org/10.14740/jocmr4666
- to the editor
- References
| to the editor | ▴Arriba |
Lipedema syndrome is described as a clinical condition of increased redistribution of adipose tissue to the extremities, which leads to extremity enlargement and can have psychological consequences that affect quality of life. Regarding symptoms, pain is the main complaint. Therefore, physical appearance and pain are the two main objectives to be addressed. They usually have a family history, and can be observed since childhood, but obesity is better defined. Obesity is another aggravating factor that can cause damage to the lymphatic system earlier than in obese people.
In pathophysiological terms, the main changes are related to adipose tissue and microcirculation, detecting a greater number of vessels in the dermis and a greater number of macrophages in the skin and adipose tissue. Several studies report lymphatic changes [1-3]. One of these studies found an increase in the area of lymphatic vessels, but not in the number of vessels, suggesting regional lymphostasis.1,2].
The pathophysiological mechanisms lead to an increase in the volume of adipose tissue and the formation of microcirculatory lymphedema. So those are the two big questions to address. The authors report that people with lipedema and body mass index (BMI) less than 30 kg/m2may develop subclinical and clinical systemic lymphedema starting in the lower extremities bilaterally [4,5]. However, unilateral onset may occur when associated with lymphatic or venous system damage.
One study shows that, as the patient becomes obese, there is a significant increase in subclinical and clinical systemic lymphedema of the lower limbs, which can progress to the trunk, followed by the upper limbs.6]. Patients with BMI less than 30 kg/m2have a lower frequency of subclinical systemic lymphedema. Pain symptoms may occur in the legs, but may improve after one or two lymphatic drainage sessions. The movements must be linear in the direction of the corresponding lymph nodes, exclusively in the course of the great saphenous vein. This treatment is sufficient to resolve the symptoms.
An important note is that obesity is a disease and lipedema is a medical condition that can be exacerbated by obesity. However, there are some obese people with wide legs and arms but belly fat. In classic lipedema we do not have abdominal fat. This is the biggest doubt regarding the classification of these obese patients with lipedema of the extremities. There are currently no data that can differentiate this obese patient. Preliminary evaluations of these obese patients with multisegmental and multifrequency bioimpedance behave like obese patients and do not show a pattern of changes in the lymphatic system as occurs in lipedema. However, we are developing this research to have more concrete data.
Pain is usually due to edema and is present when manual compression is performed on the leg, but the pain can be referred and depends on the intensity of the edema. A scientific method of lymphatic drainage relieves or normalizes pain in one or two sessions; thus confirming the hypothesis that the pain is due to edema.
Approximately 10% of these women have idiopathic cyclic edema (study in publication phase) and approximately 80% develop cellulitis [7-10], which are two important causes of edema and limb enlargement. Therefore, it is essential to diagnose the association of these four causes of extremity enlargement: lipedema, obesity, idiopathic cyclic edema and cellulite.
Idiopathic cyclic edema is an aggravating factor of lipedema, therefore, another aggravating factor for edema. We have patients with this characteristic, and with the treatment of idiopathic cyclic edema, there was only a reduction in lymphedema.
The common aspect among these four clinical conditions is the deterioration of the lymphatic system. In cases of lipedema, lymphostasis and cellulitis, proper lymphatic drainage techniques can resolve symptoms and reduce limb circumference.8,9]. However, in lymphedema caused by obesity, there is alteration in capillary permeability and damage to lymphatic vessels. Therefore, the only therapeutic option is to lose weight and avoid further damage to the lymphatic system, such as trauma and infections. However, if the patient has idiopathic cyclic edema, it is necessary to use medications that control the problem and affect capillary permeability, such as calcium dobesilate, aminaphthone andGinkgo biloba.
This is the clinical basis that, when performed correctly, can reduce limb volume within physiological standards and improve symptoms. However, after this therapy, some women may have disproportionate body parts, which can lead to psychological problems. In selected cases, these patients may opt for liposuction, but it is important to rule out the possibility of subclinical systemic lymphedema and idiopathic cyclic edema, which greatly aggravate the postoperative period.
In one study, the authors did not detect significant changes in the expression of genes associated with inflammation in adipose tissue-derived stem cells (ASCs) in lipedema or differentiated adipocytes. However, the results suggest that ASC isolated from the stromal vascular fraction in lipedema have greater potential for adipogenic differentiation than healthy ASC.11]. Other studies show that there are several abnormalities in lipedema. However, the therapeutic approach only addresses the lymphatic system.
This proposal offers new concepts in the treatment of lipedema on a therapeutic basis to alleviate the discomfort caused by lipedema. However, the main problem of lipedema is obesity.
expressions of gratitude
None to declare.
Financial Disclosure
None to declare.
Conflict of interests
None to declare.
informed consent
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Author Contributions
Study design: Godoy JMP. Both authors contributed to data analysis and interpretation, data collection, article writing, critical text review and statistical analysis; and assumed overall responsibility for the study. Both authors read and approved the final version sent.
data availability
Data supporting the findings of this study are available from the corresponding author upon reasonable request.
| References | ▴Arriba |
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doi published - Redondo Galan C, Garcia Bascones M, Marquina Valero MA. LIPOEDEMA: SYMPTOMS, DIAGNOSIS AND TREATMENT. A literature review]. Rehabilitation (Madr). 2019;53(2):104-110.
doi published - Al-Ghadban S, Cromer W, Allen M, Ussery C, Badowski M, Harris D, Herbst KL. Dilated blood and lymphatic microvessels, angiogenesis, macrophage enlargement and adipocyte hypertrophy in thigh skin lipedema and adipose tissue. J Obes. 2019;2019:8747461.
doi published - Pereira de Godoy JM. Subclinical systemic lymphedema due to obesity as a cause of clinical lymphedema: a new concept. Medical Hypothesis 2019;131:109312.
doi published - de Godoy JMP, Godoy MFG. Diagnostic criteria and clinical evolution of systemic lymphedema due to obesity: bioimpedance analysis. Ann Med Health Sci Res. 2019;9:420-442.
- Pereira de Godoy LM, Pereira de Godoy HJ, Pereira de Godoy Capletto P, Guerreiro Godoy MF, Pereira de Godoy JM. Lipedema and evolution to lymphedema with the progression of obesity. i heal. 2020;12(12):e11854.
doi - Pereira de Godoy JM, Pereira de Godoy HJ, Pereira de Godoy LM, Guerreiro Godoy MF. Prevalence of idiopathic cyclic edema in women with lower limb lymphedema. J Clin Med. 2017;7(1):2.
doi published - Pereira de Godoy JM, Pereira de Godoy HJ, Sene Souza AA, Budtinger Filho R, Fátima Guerreiro Godoy M. Lipolymphedema associated with idiopathic cyclic edema: a therapeutic approach. Case Representative Vasc Med. 2017;2017:5470909.
doi published - de Godoy JM, Barufi S, Godoy Mde F. Lipedema: does aesthetic cellulite worsen the circumference of the extremities? J Cutan Aesthet Surg. 2013;6(3):167-168.
doi published - de Godoy JM, de Godoy Mde F. Assessment of the prevalence of concomitant idiopathic cyclic edema and cellulitis. Int J Med Sci. 2011;8(6):453-455.
doi published - Al-Ghadban S, Diaz ZT, Singer HJ, Mert KB, Bunnell BA. Increased leptin and PPAR-gamma gene expression in lipedema adipocytes differentiated in vitro from adipose tissue-derived stem cells. cells. 2020;9(2):430.
doi published
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FAQs
What is the new treatment for lipedema 2022? ›
Tumescent liposuction, which uses a solution injected into the tissue to decrease pain and bleeding, has become a standard procedure in surgical treatment of lipedema.
What is the successful treatment of lipedema? ›Tumescent liposuction
The surgeon uses a gentle, vacuum-like instrument to remove excess fat. Tumescent liposuction is the most effective treatment for Lipedema, and it can prevent recurrence for an average of five years.
- Choose a Healthy Way of Life.
- Opt for a Healthy Skincare Routine.
- Make Healthy Dietary Changes.
- Regular Exercise.
- Lifestyle Changes.
- Decongestive Therapy and Compression Therapy.
- Invasive Therapies.
The only way to ultimately stop the advancing stages of lipedema in their tracks is through surgical intervention, such as water-assisted liposuction, manual lipedema extraction, and other innovative fat-extracting techniques targeted to specifically remove painful, accumulated fat buildup.
Will there be a cure for lipedema? ›Although there is no specific cure, lipedema can be well-managed like many other chronic health concerns. With proper diagnosis and treatment, many lipedema patients experience a significant improvement in symptoms and do well long-term.
What makes lipedema worse? ›However, lipedema frequently does worsen with time due to the general trend toward increasing body weight and obesity (which is itself a progressive disease) with age. Psychological distress is often also a progressive disorder, one that typically amplifies feelings of pain and diminishes willpower and general health.
How do you stop lipedema getting worse? ›- Manual Lymphatic Drainage Massage (referred to as MLD).
- Adopting a diet focused on low levels of carbohydrates and limited refined foods.
- Beginning and maintaining regular exercise activity that's low impact, such as water exercise.
Vitamin D3: Lipedema patients are typically deficient with Vitamin D, an essential supplement that plays a critical role with your immune system. It also helps your bone, muscle, and nervous system health.
Can lipedema fat disappear? ›There is currently no cure for lipedema. However, patients can slow down its progression with surgical treatments like liposuction to remove painful subcutaneous fat buildup, as well as nonsurgical options like massage therapy, compression garments, healthy dietary choices, and remaining active.
Does coolsculpting work on lipedema? ›DON'T: Treat Lipedema with Fat Freezing
Fat freezing—also known as cryolipolysis (or Cool Sculpting) uses cold temperature to reduce fat deposits in certain areas of the body. The procedure is designed to reduce localized fat deposits that do not respond to diet and exercise.
Is lipedema a hormone imbalance? ›
Lipedema is a painful fat disorder which predominantly affects women and develops during times of hormonal fluctuation including, but not limited to, puberty, pregnancy, and menopause [1,6].
Is lipedema an autoimmune disorder? ›For some women it is impossible to lose weight because of an under-diagnosed autoimmune disorder many people have never heard of called lipedema. Los Angeles-based surgeon Dr. Jaime Schwartz diagnosed Cruz with the condition. As many as 1 in 9 women may suffer from the condition, according to Dr.
Can lipedema be reversed with exercise? ›Loss of muscle mass and mobility issues are common problems for women with lipedema. There's no miracle cure; you have to want it, and you have to work at it. Fortunately, there are many lipedema exercises to perform at any level of fitness, and even modest lipedema exercise can have a significant benefit.
Can you shrink lipedema? ›Lymph sparing tumescent liposuction and water jet assisted liposuction are the only methods that are known to reduce the number of lipedema fat cells at this time.
What diseases are associated with lipedema? ›Lipedema is described as “adiposis dolorosa,” or painful fat, and is related to the more extreme adipose tissue disorder, Dercum's disease.
How do you stimulate lymphatic drainage in your legs? ›Place one hand on your shin and the other hand on the back of your lower leg, just below your knee. Gently stretch the skin towards your upper leg and release. Shift your hands down and repeat this upward motion until you reach your ankle. Remember to stretch and release the skin up towards your knee.
Is lipedema treatment covered by insurance? ›For your lipedema surgery to be covered by insurance, there must be a medical reason to do so. This reason can be the presence of swelling, pain or problems with mobility and other activities of daily living.
Does lymphatic massage help lipedema? ›If you're living with lymphedema, lipedema, or a similar condition, you can take steps to get relief from pain and the other symptoms at home. Lymphatic massage can be used to relieve the swelling in your arms, legs, or other affected areas. The technique works by helping to promote lymphatic drainage.
Does ketogenic diet help lipedema? ›Lipedema adiposity is resistant to weight loss diets, but may respond to ketosis. Ketogenic diets modulate pain in lipedema independent of weight loss. Ketogenesis positively impacts lymph vessel integrity and lymph transport.
What happens if you don't treat lipedema? ›If left undiagnosed, it leads to more risk of health concerns and in most cases, emotional issues. Although Lipedema starts off as a cosmetic concern for women, if left untreated, it can have life-threatening consequences. Affecting up to 11% of women, Lipedema becomes a painful and, in some cases, crippling disorder.
How do you drain fluid from your legs? ›
- Use pressure. If edema affects an arm or leg, wearing compression stockings, sleeves or gloves might help. ...
- Move. Moving and using the muscles in the part of the body that's swollen, especially the legs, might help move fluid back toward the heart. ...
- Raise. ...
- Massage. ...
- Protect. ...
- Reduce salt.
Being active is beneficial when you have lipedema: it reduces pain, manages your weight, and improves your overall well-being. Exercises for lipedema should focus on building muscle strength and aerobic exercises.
What teas for lipedema? ›Here are some herbs for an extra boost of anti-inflammatory action: ginger, garlic, turmeric(with black pepper for absorption), cardamom, green tea, rosemary, and cinnamon.
Does a gluten free diet help lipedema? ›A gluten-free or low-gluten diet may be recommended as it can have anti-inflammatory effects for lipedema patients.
Does selenium help with lipedema? ›Background: Selenium is a trace element, which is utilized by the human body in selenoproteins. Their main function is to reduce oxidative stress, which plays an important role in lymphedema and lipedema.
Does Kybella work on lipedema? ›Kybella is FDA approved only to treat submental fat or fat under the chin. It can be used off label to improve lipoma or lipedema but it will not remove them.
How does a vibration plate help lipedema? ›WBV promotes lymphatic drainage and prevents the excessive accumulation of lymph fluid in the body, which contributes to the effectiveness of lipedema treatment.
Can lipedema cause neuropathy? ›Lipedema patients commonly report allodynic and neuropathic pain in the affected tissues that is, importantly, unique from symptoms of obesity or lymphedema [4]. Pain is critical to address in the clinical management lipedema as over 90% of patients report some tissue pain [5].
How does guaifenesin help lipedema? ›Guaifenesin belongs to a class of drugs known as expectorants. It is this drug, Guaifenesin, an expectorant, that is sometimes prescribed for Lipedema. It works by helping to break up coagulated protein in adipose tissue.
How do you tone lipedema? ›Lipoedema exercise programs include a mixture of building muscle strength and incorporates aerobic exercise. Good examples of aerobic exercises are Yoga, Pilates, Nordic Walking, cycling, or exercise in water. Swimming or water aerobics reduces the strain on your joints and muscles and also improves lymphatic flow.
Can intermittent fasting help with lipedema? ›
Neither diets nor fasting or exercise will bring the desired success for lipoedema as a fat reduction in the affected parts will not be achieved. You will only lose weight in the “healthy” parts of your body. That is why these methods are not an option treating lipoedema.
Can an endocrinologist help with lipedema? ›For now, your endocrinologist may be a key player involved in weight management as well as the detection and treatment of thyroid issues, which may affect a third of women with Lipedema.
Is lipedema caused by stress? ›Lipedema can be triggered by anything that can alter hormonal imbalances. Known lipedema triggers include puberty, pregnancy, peri-menopause, menopause and following gynecologic surgery. Stress can also increase cortisol levels that can, in turn, cause lipedema.
Is lipedema a genetic disorder? ›Lipedema is an under-recognized condition, often misdiagnosed as lymphedema or dismissed as simple obesity. We present a series of pedigrees and propose that lipedema is a genetic condition with either X-linked dominant inheritance or more likely, autosomal dominant inheritance with sex limitation.
What can mimic lipedema? ›Lipedema is often misdiagnosed as obesity, lymphedema, or chronic venous disease, although these diagnoses can often occur concomitantly [1,10,11].
What gene causes lipedema? ›The genetic etiology of lipedema is not yet fully understood. Genes associated with syndromic subcutaneous fat accumulation have been identified, such as POU1F1A, NSD1, ELN, FZD9, MLXIPL, and ALDH18A1 [2].
Can lipedema affect your heart? ›If lipedema is not treated, complications that are detrimental to mental health and life-threatening can occur. These complications include mental problems such as eating disorders and generalized complications including hypertension, diabetes, and heart failure.
What are the best exercises to drain the lymphatic system? ›Physical activity encourages fluid to drain into the lymphatic system in the abdomen. Walking, swimming, yoga, pilates and Tai chi all might help to encourage the lymph to move. Pelvic floor exercises may also help.
What causes lipedema to progress? ›The reason why lipedema progresses is usually due to inadequate treatment or an increase in your weight. Weight management is, therefore, an integral part of lipedema treatment. The goal of weight management with lipedema is to improve your overall well-being and fitness instead of losing weight with diets.
What is the pinch test for lipedema? ›A simple pinch test can often tell you whether you have lipedema. To do this, pinch the skin lightly in the areas of the body that may be affected. If you experience disproportionate pain, you may suspect lipedema.
Can lipedema cause belly fat? ›
Patients with lipedema (or lipoedema) can experience an abnormal buildup of body fat in different areas of the body. While this accumulation of lipedema fat occurs most in the legs, thighs, and arms, areas such as the stomach and the hips are possible too.
Can lipedema cause kidney problems? ›Symptoms may progress in advanced stages of lipedema that might be associated with increased cardiovascular and renal diseases.
What supplements help with lipedema? ›Common ingredients of fat burning supplements are green tea, caffeine, chromium, carnitine, and conjugated linoleic acid. The use of fat burners could act synergistically with a healthy diet and physical exercise for decreasing adipose tissue deposition in patients with lipedema and resolve related health issues.
Does coolsculpting work for lipedema? ›DON'T: Treat Lipedema with Fat Freezing
Fat freezing—also known as cryolipolysis (or Cool Sculpting) uses cold temperature to reduce fat deposits in certain areas of the body. The procedure is designed to reduce localized fat deposits that do not respond to diet and exercise.
Mucinex / guaifenesin may help pain or it may work as an expectorant in lipedema tissue and thin out extracellular proteins. However, there are no studies to support these theories in lipedema.
Is lipedema genetic? ›Lipedema is an under-recognized condition, often misdiagnosed as lymphedema or dismissed as simple obesity. We present a series of pedigrees and propose that lipedema is a genetic condition with either X-linked dominant inheritance or more likely, autosomal dominant inheritance with sex limitation.