Lipedema vs cellulite, stages of lipedema and more (2023)

This blog discusses lipedema vs cellulite, stages of lipedema and much more! Lipedema (known as lipedema in the UK) is a connective tissue disease that belongs to the lipedema familyRare Fatty Disorders (RADs). This leads to excessive accumulation of fat under the skin (subcutaneous fat).

This blog is not intended to diagnose or treat any medical condition. You can read this blog top to bottom or use it to jump to a section.index

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What is lipedema?

Lipedema is a chronic condition characterized by loose, fibrotic fatty tissue. It is often painful and hence it is also calledPainful Fat Syndrome. Lumps of fat can usually be present all over the body which, if present, can help make a definitive diagnosis.

The lipedema nodule

Fat lumps are one of the distinguishing features of lipedema - what would differentiate it from both cellulite and normal body fat and lymphedema. Nodules can be hardspheroids– described as feeling like peas, beans or grains (Herbst, 2015).

The spheroids are about 5 mm by 5 mm up to 10 mm by 10 mm, distinct from each other but grouped together (Herbst, 2015).

They are actually hard calcified necrotic fat that forms due to connective tissue disorder. There is another type of larger and softer fat lump calledlipoma. These may also be present in lipoedema (Herbst, 2015).

Sometimes, instead of nodules, the skin looks like an orange peel, as it is called.Orange skinwith a thick and bumpy appearance. It can sometimes be difficult to distinguish between normal fat in cellulite and diseased fat in peau d'orange.

Lipedema vs. cellulitis

cellulitisit is a cosmetic problem with no serious medical implications and occurs when fat and connective tissue pushes and pulls on the skin.

In contrast,lipedemait is a chronic progressive disease with multiple comorbidities (read full list). Lipedema can greatly benefit from early diagnosis and treatment. So if you're not sure if you have cellulite or lipedema, read on.

Diagnosis Lipoedema

Diagnosing lipedema is critical to starting proper treatment, and the sooner you get a definitive diagnosis, the better. But... finding a doctor who can reliably assess and diagnose lipoedema is a challenge.

Unfortunately, it is the norm rather than the exception that people with lipedema struggle for years and even decades to be informed about obesity and/or cellulite and miss the correct diagnosis of lipedema.

If you are in this situation now, you must continue to defend yourself. find oneCertified Lymphedema Therapisthe can then recommend a doctor who is familiar with lipoedema.

How is lipedema diagnosed?

There are several parts to a diagnosis of lipedema, including:

Physical exam

Lipedema tends tobilateral and symmetrical(right and left equal). But this isdisproportionate- not equal not equal upper and lower body - depending on the exact type (see below for types of lipedema), but most commonly appears as disproportionately larger hips and thighs and smaller abdomen and trunk and unaffected hands and feet.

Here are some important aspects of the physical exam (Ghods, 2020, Fall, 2021):

• Cuffs and ankle cuffs (this is a typical sign of lipoedema)
• Negative Stemmer (see below)
• Broken blood vessels or spider veins (telangiectasia) around fatty deposits
• ankle pronation
• Abflachung des Plantarbogens
• Hyperlordotic curvature in the lumbar spine (a large inward curve in the lower back)
• Knee valgus, also called knock-knee (ankles not touching when knees are together)
• Hypermobile Joints - This is present in about 50% of cases

vote sign

Stemmer's sign is a simple physical exam used to diagnose lymphedema. Examiner failure to pinch the skin between the second and third toes is a positive Stemmer sign. In a study of 110 patients, the Stemmer sign was found to be 92% accurate in detecting lymphedema (Goss, 2019).

If you have a positive Stemmer's sign, it means you probably have lymphedema. Now it must be determined whether you have lymphedema or lipo-lymphedema.

medical history

If you have lipedema, you may find that your limbs feel heavy. In Stage I, you might describe your skin as feelingspongy.This is important to discuss with your doctor as well as other questions.

You can also complain about:

• pain and easy bruising
• Worse pain later in the day
• Difficulty losing weight in areas of lipedema when the rest of the body responds to diet and exercise
• Skin that feels cold in areas of lipedema

family history

Your diagnostician should ask about your family history. Try looking for family photos, paying special attention to your female relatives. This can sometimes be a challenge as your relative may have taken steps to cover their legs to avoid being featured in photos.

if they had"Stove Legs"as they were sometimes called, they may have been covered up. Talking to your relatives and having this family history can help shed light on your background history and help with the diagnosis.

Although they are mostly female relatives, check the family history of both your father's family and your mother's family as it is not inherited from your mother's side only.

Medical exams

This is not a specific test for lipedema, but here are a few to help make a diagnosis.

ultrasonicLipoedema shows thinner skin and increased thickness of subcutaneous adipose tissue, which becomes more prominent in the calf and lower leg. Thickness is classified as follows: 12-15mm is light, 15-22mm is moderate, more than 20mm is significant, and more than 33mm is thick (Vyas, 2022). In the case of lipoedema, however, this is not significant, as obesity can also present similar alterations.

Ultrasound can also look for peripheral vascular disease. This would indicate that the leg veins are not efficient and some blood fluid is leaking and pooling.

However, this also does not rule out lipedema, as many women can have both lipedema AND vein problems (see comorbidities below), but it can help to get the right treatment for your veins.

lymphatic scintigraphy, is a test in which dye is injected into the tissues of the toes and given time to be absorbed by the lymphatic vessels. Your legs will then be examined with the room lights off and a special light to visualize the function of your lymph vessels.

Unfortunately, this also does not completely rule out lipedema, as individuals may have just lipedema, lymphedema alone, or a combination of the two - calledlipolinfedema. But getting this information is vital!

Genetic test for lipedema, is a test that can give you a definitive yes, but ... at the moment only one genetic mutation has been identified, vizAKR1C1. However, other genetic mutations are also being researched (Michelini, 2022).

DEXA-Scan(Dual Energy X-ray Absorptiometry Scan) is used to measure bone mineral density, but it can also measure fat and lean mass. A higher ratio of fat to lean mass may indicate lipedema (Vyas, 2022).

After physical examination, medical examination, and medical history, the diagnosis depends on the physician's clinical experience, other than a positive AKR1C1 genetic test, there is no single simple diagnostic measure.

Summary: Lipedema x Cellulite

In summary, here are the differences between lipedema and cellulite:

cellulitis

• Cosmetic problem where the skin looks bumpy and uneven
• no swelling
• no fat knots
• Painless
• normal bruises

lipedema

• Painful
• light bruises
• fat lumps under the skin
• Restoration of hands and feet, which may give the appearance of an ankle cuff, wrist cuff, or elbow over hand, but not in 100% of patients
• Swelling of the limbs may occur with pits, but need not be present for a diagnosis
• ankle pronation
• Abflachung des Plantarbogens
• Herpetic lordotic curve in the lumbar spine
• white knee
• Hypermobile Joints (50%)

Lipedema x Obesity

A similar catalog of criteria can help with differentiationLipedema against obesity. Obesity is often described as apple- or pear-shaped. Keeping body fat around the hips and thighs - this is also called a pear shapeginoideobesityand is more common in women, especially premenopausal women.

When fat is kept around the abdomen, it is called apple shape orandroid obesity. The android is metabolically more dangerous, as fat can be stored in the visceral layers and accumulate in the liver and other organs.

It is the gynoid or pear shape that is most difficult to distinguish from lipedema because lipedema also accumulates around the hips and thighs. Even more confusing is the fact that obesity is often associated with lipedema.

What may help distinguish obesity from lipedema is that lipedema fat is very difficult to lose, whereas gynoid fat will likely be reduced in proportion to other fats in your body as you lose weight.

So while two women, one with gynoid body fat and one with lipedema, pursue weight loss strategies like healthy eating and exercise, women with normal gynoid body fat distribution may lose weight all over their bodies - although it's not the same. everywhere. and she may lose some in more places than others, a woman with lipedema can become very thin in her trunk and non-lipedema areas, but still remain the same in the lipedema areas.

Lipedema fat vs. normal fat

Lipedema fat has a different structure. Although lipedema or lipedema means "fat edema", it does not accurately describe the structure of lipedema fat.

In lipedema there is adipocyte hypertrophy – enlarged fat cells, there is also more fibrosis (scarring) and more macrophages, indicating inflammation. There is more angiogenesis – the formation of new blood vessels, indicating that the blood vessels are altered in lipedema (Al-Ghadban, 2019).

Here is a description of the pathogenesis of lipedema (Al-Ghadban, 2019):

• Hypertrophic fat cells (enlargement of fat cells)
• Macrophages (immune cells) surround fat cells
• Crown-shaped structures form
• Blood capillaries dilate and new blood vessels form
• Increase blood plasma flow to fat cells
• Fat cells are unable to remove plasma
• Excess fluid in fat stimulates its growth
• Inflammation causes fibrosis and difficulty losing weight
• Interstitial fluid (fluid inside the cell) stagnates - activates nerve endings and causes pain

Conclusion - the structure of fat is abnormal, and these pathological changes have significant consequences.

Lipedema vs Lymphedema

What about lipedema and lymphedema? Lipedema can often be misdiagnosed as lymphedema, and to make matters even more difficult, some people have it too.lipolinfedema– a combination of the two conditions. Here are some of the differences between lipedema and lymphedema.

lipedema

• Tends to be symmetrical from left to right
• Gentle on hands and feet
• Tends to focus on hips, thighs, legs, upper arms and sometimes lower abdomen
• No corrosion
• sign downvotes
• Painful
• fat nodules
• Fat pads above or below the knee
• Occurs mainly in girls and women and minimally in men
• Tends to present during puberty

lymphedema

• May affect only one side or two sides asymmetrically
• pitting edema
• sign positive votes
• May occur after cancer treatment, surgery, or injury
• May be primary and present at birth or occur spontaneously
• Can be reduced with decongestive therapy
• no fat knots
• Occurs in both men and women
• Can occur at any time

Similarities Between Lipedema and Lymphedemaalso exist, as

• Primary lymphedema and lipedema appear to have a genetic component
• Both are inflammatory diseases
• Stage III lipoedema can include lymphedema
• Both can occur in conjunction with venous insufficiency
• Both can benefit from compression garments.
• Both can be treated by certified lymphedema therapists
• Both can benefit from itanti-inflammatory diet

lipolinfedema

To make things even more difficult to get a proper diagnosis, there is a condition called lipolymphedema where people have bothLipedema And Lymphedemaat the same time. This is also referred to asstage IV lipoedema(Steps see below) (Autumn, 2015).

Not everyone with lipedema will develop lymphedema, but it can develop at any stage of lipedema (Herbst, 2015). Pitting edema and a positive Stemmer's sign are indicators of lymphedema.

When lymphedema is present, the likelihood of cellulitis and sore development is greatly increased.

What causes lipedema?

The cause of lipedema is still unclear, but several theories are being considered. One is that it is related to estrogen and therefore is predominantly found in females and usually first appears during puberty and can get worse during hormonal changes such as pregnancy, contraception or menopause.

miss lipedema

Lipedema pain has been described as “dull, heavy and aching” (Shavit, 2018). It can be stimulated by touch or occur after sitting or standing for a long time. I've heard women say that they can't stand having a cat cradled or holding a baby, or having a regular Swedish massage that is painful for them.

While this can be alleviated by wearing compression garments, putting the garment on can be uncomfortable and may take some getting used to. Other pain relief can be obtained through manual lymphatic drainage, compression pump and liposuction. To seelipedema treatment.

Stages and types of lipedema

Lipoedema is divided into stages and types. The types of lipedema depend on the location of the lipedema fat in the body. Disease stage indicates the extent of disease progression, and progressive stages are accompanied by additional disease signs and symptoms.

types of lipedema

Type 1 lipedema

This type concentrates the lipedema fat around the hips and buttocks. This type can also have a "saddlebag" appearance.

Type 2 lipedema

This type concentrates the fat from lipedema from the buttocks to the knees. There can often be lipedema fat hanging from the top of the knee, making it difficult to see the knee. It can also hang down into the knee and look like a lobe. You will often see a dramatic difference in the skin on your thighs compared to your calves and shins.

Type 3 lipedema

Type 3 lipedema extends from the buttocks to the ankles. This type can show the ankle cuff, making it difficult to wear boots or shoes that go above the ankle.

Type 4 lipedema

Lipedema in this type occurs in the arms, usually concentrated on the back of the arm, but it can extend from the shoulder to the wrist, or from the shoulder to the elbow, or from the elbow to the wrist. The diseased fat can protrude past the elbow and when the arms are stretched out it can look like a bat wing.

This type can also include the lower body, in which case it is said to be combined with another type. Common combinations are types 2 and 4 and types 3 and 4 (Vyas, 2022). See below for more information on lipedema arms.

Lipedema type 5

This type is from the knees down, but like type 3 would probably be easier on most people's feet and may have a visible ankle. This is the rarest type (Vyas, 2022).

arms with lipoedema

Lipedema in the arms or type IV lipedema occurs in about 30% of cases. It can also occur only in the arms without involvement of the legs, but it is rare (Reich-Schupke, 2012).

Lipedema in the arms also tends to be symmetrical, which would differentiate it from lymphedema, which tends to be worse on one side.

stages of lipedema

According to (Autumn, 2015 and Vyas, 2022) the stages are:

stage I lipoedema

There is a normal-appearing smooth skin surface with increased subcutaneous fat. You may feel lumps under your skin. Pain and mild bruising may occur.

stage II lipoedema

Dimples in the skin and the fat under the skin to give the skin an uneven appearance, or dimpling which may include lipomas. At this stage, the skin may have a mattress-like appearance caused by the thickening and contraction of the connective tissue overlying the fat.

Stage III Lipodema

Large accumulations of subcutaneous fat cause lobules that can distort the normal silhouette and appear as large skin folds. The body has a more pronounced disproportionate appearance, with the lower body appearing larger than the upper body. Joints, mobility and balance can be affected.

Typical signs of this may include fat on the sides of the hips, "saddle bags", fat on the upper part of the buttocks, "shelf of buttocks", fat hanging over the top of the head or on the inside of the knee, fat protruding beyond the elbows, " Bat wings".

Those with stage 3 lipedema have greater and more serious complaints about their condition, including but not limited to: blood clots, burning pain, constipation, flu-like symptoms, high body temperature, nausea, and sleep apnea (Herbst, 2015) .

stage IV lipoedema

This is the stage where lymphedema develops and this is known as lipo-lymphedema. As staging increases, so does fibrotic tissue and pain (Ghods, 2020).

Lipedema types and stages

When considering the type and stage, you can label a case of lipedema as "Type 3, Stage IV", etc., which helps to identify the location and severity. Whatever the type of person, they present themselves as disproportionately fat – which means that the parts of the body with lipedema are larger than the parts without.

For example, one of my clients notes that she wears a size 8 top and a size 14 bottom and that her waist is 34 inches and her hips are 54 inches. This helps demonstrate the disproportionality of lipedema.

Although lipedema is disproportionate from top to bottom, it is often symmetrical from right to left. This helps to differentiate it from lymphedema, which can only affect 1 leg or 1 arm, whereas lipedema usually affects both more or less equally.

Lipedema comorbidities

Comorbidities are other conditions that occur at the same time, sometimes called comorbidities. Several disorders appear to be linked to lipedema as they occur more frequently than randomly.

The other conditions most commonly associated with lipedema are (Ghods, 2020, Fall, 2021):

• obesity
• hypothyroidism
• migraine
• Depression
• Ehlers-Danlos Syndrome
• SOP
• Venenkrankheit
• lipoma
• sleep apnea
• Anguish
• eating disorder
• migraine

While this may seem like one problem after another, there is good news. It appears that people with lipedema appear to be protected from diabetes and high cholesterol, as these conditions are much less common than people with a similar BMI.

The rates of diabetes and dyslipidemia are 5% and 7%, respectively. Although they still need treatment for these conditions, it has been found to take years compared to the population without lipedema (Ghods, 2020).

Lipedema in men

Lipedema occurs mainly in women, but it can also occur in men. It is described as occurring along with testosterone deficiency, growth hormone deficiency, liver disease or high estrogen levels. It has also been described as occurring in hypogonadism and hyperestrogenemia (Herbst, 2012, Ghods, 2020).

prevalence of lipedema

The prevalence of lipedema is estimated at 1 in 72,000 people (Vyas, 2022). However, since it is often undiagnosed or misdiagnosed as obesity or lymphedema or other misdiagnoses, the prevalence number is likely higher.

Conclusion about lipedema

If you suspect you have lipedema, it's important to get a diagnosis and treatment. Keep advocating for yourself and connecting with others who have lipedema for support. A certified lymphedema therapist in your area is probably the best place to get a diagnosis, as they have a lot of knowledge about lipedema and lipolymphedema. Don't forget that your diet is also important!

Best diet for lipedema

See my blog calledDiet for Lipedemato explore the best diet for lipedema.

Read toolipedema treatment.

References for Lipedema vs. Cellulitis

Al-Ghadban S., Cromer W., Allen M. et al. ddilated blood and lymphatic microvessels, angiogenesis, macrophage enlargement, and adipocyte hypertrophy in thigh skin lipedema and adipose tissue.J Obes. 2019;2019:8747461. Published March 3, 2019. doi:10.1155/2019/8747461

Ghods M., Georgiou I., Schmidt J., Kruppa P.Disease progression and comorbidities in patients with lipedema: a 10-year retrospective analysis. Dermatol Ther. 2020 nov;33(6):e14534. doi: 10.1111/dth.14534. Epub 2020, 22 de novembro. PMID: 33184945.

Goss JA, Greene AK.Sensitivity and Specificity of the Stemmer Sign for Lymphedema: A Clinical Lymphoscintigraphic Study.Plast Reconstr Surg Glob Open. 2019;7(6):e2295. Published on June 25, 2019. doi:10.1097/GOX.0000000000002295

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Herbst K, and others Ch.Lipedema fat and disease symptoms increase as the stage progresses. Medicine Archive. 2015 7 4(10)1-8.

autumn cl.Rare obesity disorders (RADs) masquerading as obesity.Acta Pharmacol Sin. 2012;33(2):155-172.

autumn cl.Subcutaneous adipose tissue disorders: Dercum's disease, lipoedema, familial multiple lipomatosis, and Madelung's disease. . . . [Updated December 14, 2019] In: Feingold KR, Anawalt B, Boyce A, editors. Endotext [web]. South Dartmouth (MA): MDText.com, Inc.; 2000-.

Michelini S, Herbst KL, Precone V, Manara E, Marceddu G, Dautaj A, Maltese PE, Paolacci S, Ceccarini MR, Beccari T, Sorrentino E, Aquilanti B, Velluti V, Matera G, Gagliardi L, Miggiano GAD, Bertelli M .A multigene panel to identify lipedema predisposing genetic variants through a next-generation sequencing strategy. J Pers. With. February 11, 2022;12(2):268. doi: 10.3390/jpm12020268. PMID: 35207755; PMC ID: PMC8877075.

Reich-Schupke S, Altmeyer P, Stücker M.Thick legs – not always lipoedema. J Dtsch Dermatol Ges. 2013 March;11(3):225-33. doi: 10.1111/ddg.12024. Epub December 11, 2012. PMID: 23231593.

Vyas A, Adnan G.lipedema. February 16, 2022. In: StatPearls [web]. Treasure Island (FL): StatPearls Publishing; 2022 January–. PMID: 34424639.