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THE CONDITION OF LIPOEDEMA
Dr. Karen Herbst, one of the leading international researchers on lipoedema, defines it as “fluid- containing fat” or, more precisely, “the development of subcutaneous fat independent of caloric intake and physical activity”.
In simpler terms, lipoedema involves “modified fat” that accumulates excessively in the subcutaneous layer and exhibits irregular distribution. Lipoedema is not a consequence of being overweight; it is not excess fat due to diet but rather a condition that alters adipocytes.
Lipoedema is a chronic, degenerative, and disabling genetic condition affecting adipose tissue, often accompanied by oedema, systemic inflammation, and pain. Although lipoedema is not curable, it is now well treatable.
In fact, lipoedema is a little-known disease even among medical professionals: it is often confused with other conditions such as lifestyle-induced obesity, gynoid and localized obesity, lymphoedema, and even other aesthetic-related conditions (like common “cellulite“). It was officially recognized by the WHO only in 2018 and is considered a rare disease.
TYPES AND SIGNS OF LIPOEDEMA
Lipoedema manifests as a symmetrical and bilateral proliferation of fat that affects the legs and sometimes the arms, while the hands and feet remain unaffected.
Depending on the areas involved, there are 5 types of lipoedema.
When the condition affects the lower half of the legs, fat deposits abruptly stop at the level of the ankles, causing a sharp demarcation between pathological and normal tissue. This characteristic aspect of lipoedema has been defined in various ways: the “sock sign,” the “cup sign,” or the “cognac glass sign.”
When it affects the upper limb, the fat deposits involve only the arm (or sometimes the forearm) but always leave the hand unaffected.
The fat deposits abruptly stop at the elbow or wrist, defining the so-called “cuff sign” or “bracelet sign.”
To determine the potential presence of lipoedema, it is necessary to take an initial lymphological consultation.
THE STAGES
Lipoedema Is characterised by three clinical and evolutionary stages based on the morphology and subcutaneous nodular structures (as defined by Meier-Vollrath and Schmeller, 2004).
Stage 1
The skin surface is normally smooth, with a thickening of the subcutaneous tissue. Upon palpation, small granules or nodules similar to polystyrene balls can be felt.
Stage 2
Irregular skin with a “mattress-like” appearance, and palpable nodules the size of peas or pearls can be felt.
Stage 3
Large protrusions of adipose tissue cause deformities of the limb, especially in the thigh and around the knee.
Stage 4
Also known as phlebolymphoedema. This is the most advanced expression of the disease, which is also associated with significant oedema (which may involve venolymphatic components).
WHY IT IS IMPORTANT TO TREAT LIPOEDEMA
A delay in treating this condition can lead to the progression of diseases with complications such as:
- Knee arthritis
- Fibrosis of the subcutaneous fat
- Lymphoedema
Without appropriate management, the condition can progress and worsen, resulting in an increasingly unacceptable quality of life.
Patients who do not receive proper treatment through a multidisciplinary approach are, in fact, inadequately treated, thus being deprived of an appropriate therapy capable of stabilizing and slowing the tissue inflammation typical of lipoedema.
An anti-inflammatory approach is at the core of the treatment, not only during the initial phase but also in the subsequent treatment phases of stabilization and maintenance.
