![]() On physical examination, she had telangiectasias, severe pain on palpation of the medial pre-tibial and genicular fat, absence of Godet or Stemmer signs, and 103 points on the QuASiL. She had been taking chlortalidone and phlebotonics. She reported discomfort in her calf, with a sensation that she could feel her veins, as well as sporadic night cramps and the appearance of spider veins in her right thigh. Her final BMI was 21.4 kg/cm 2.Ī 52-year-old woman presented with a 7-month history of ankle edema. There was significant improvement in her aesthetic concerns of gynecoid lipodystrophy ( Figure 2). After 8 months of clinical treatment, she achieved 58 points on the QuASiL (improvement of 34.83%) and total volume loss of 1230.54 mL. The patient returned with symptom improvement, with a score of 81 in QuASiL (improvement of 8.9%) and volumetric decrease of 491.62 mL. These included anti-inflammatory dietary measures, regular aquatic physical exercise, manual lymphatic drainage, and antioxidant phytotherapeutics in regular-usage doses. The bioimpedance test (Tanita ®, BC-601, Illinois, United States) showed a body mass index (BMI) of 21.2 kg/cm 2 with 29.8% body fat and lower-limb volume of 19 668.55 mL.Ī diagnosis of grade I lipedema was made and clinical treatment was suggested based on the aforementioned guidelines. Physical examination revealed sparse reticular veins, absence of Godet and Stemmer signs, and pain on palpation of areas with greater fat deposition. On past surgical history, she reported having undergone ‘hydrolipo’ 3 years prior and varicose vein surgery 5 years prior. Lymphoscintigraphy was within normal limits. Superficial and deep-color Doppler ultrasound examinations of the lower limbs (EDCV-MMII) revealed only sparse reticular structures. On the Lipedema Symptom Assessment Questionnaire (QuASiL: minimum 0, maximum 150 ) she presented 89 points. ![]() She also reported ‘cellulite’ and fat on her legs that started 5 years prior to presentation, when she started taking contraceptives, in addition to finding her legs ‘disproportionately thick’. Edema of her lower limbs worsened in the afternoon. The patient was a 39-year-old woman with persistent ‘bruising’ and pain that worsened with standing. In the present study, we describe a series of 5 cases of lipedema in various stages ( Figure 1 ), all of which were successfully treated clinically. The treatment of lipedema must be individualized and must consider the technical limitations and clinical aspects of each patient. The current literature is biased in the sense that it presents liposuction as the main treatment for lipedema, and this can lead to the misapprehension that it is its only definitive treatment. Most often the most commonly used diet strategies are anti-inflammatory, low-carbohydrate, and ketogenic diets. Diet has been presented as an adjuvant therapy however, like physical exercise, it has been little studied. However, there is thickening of adipose tissue and there is no standard pharmacological protocol to treat this. ĭiuretics are not indicated, as there is no accumulation of liquid. ![]() Manual lymphatic drainage and elastic compression have been reported to alleviate symptoms. The aim of all of these is to improve the signs and symptoms, to reduce volumes and disproportions of the affected limbs, and to prevent progression. Ĭlinical and surgical treatments for lipedema have been described extensively in international guidelines. Signs of lipedema are disproportionately increased limb volume, adipose tissue on the limbs, symmetric tissue, palpable tissue nodules, painful tissue (not always), and limb swelling (pitting or non-pitting), and the hands and feet not affected. In the absence of targeted treatment, there is no significant improvement in body dis-proportions or in signs and symptoms. ![]() Lipedema is not influenced substantially by diet or exercise. ![]() Lipedema is often misdiagnosed as obesity, lymphedema, or chronic venous disease, although these diagnoses can often occur concomitantly. The intensity of presentation is greatest in the inflammatory phase, manifesting as pain, sensitivity to touch, edema, chronic fatigue, and unprovoked ecchymosis. Its prevalence in females is believed to be 11–39%. It is a potentially aggressive disease because it limits mobility and damages the lymphatic vascular system, leading to deformities and loss of quality of life. Lipedema is an inherited, chronic, progressive disease characterized by the abnormal accumulation of fat in subcutaneous tissue, mainly in the lower and upper limbs. ![]()
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