Lipedema

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Classification according to ICD-10
R60.9 Edema, unspecified
ICD-10 online (WHO version 2019)
Classification according to ICD-10-GM
E88.20 Lipedema, stage I.
E88.21 Lipedema, stage II
E88.22 Lipedema, stage III
E88.28 Other or unspecified lipedema
ICD-10 online (GM version 2020)

The lipedema (from ancient Greek λίπος LIPOS "fat" and οἴδημα oídēma "swelling" referred to in the vernacular falsely as "breeches obesity", "breeches syndrome" or "columns leg") is a progressive disease of the fat with increased tenderness. It is characterized by the atypical symmetrical accumulation of fatty tissue on the sides of the hips and thighs and can arise from lipohypertrophy . Furthermore, the upper arms and, later, the lower legs, forearms and the neck can also be affected.

The increase in adipose tissue in the subcutaneous fat tissue includes hypertrophy and hyperplasia of the fat cells. The vessels are permeable and brittle. This causes fluid to get into the connective and supporting tissue, which also explains the tendency to hematomas. The lipedema fat contains fibrosis, enlarged and increased macrophages and often increased interleukin values, which indicate inflammation.

Lipedema is also called Allen-Hines syndrome . Both physicians ( Edgar Van Nuys Allen and Edgar Alphonso Hines Jr. ) first devoted a publication to this clinical picture in 1940 and named it lipedema. Other terms often used synonymously are lipomatosis dolorosa , Lipohypertrophia dolorosa , obesity dolorosa , Lipalgie , Adiposalgie , painful leg columns , painful Lipödemsyndrom and lipohyperplasia dolorosa . Whether they actually describe the same clinical picture is controversial.

The associated with the disease swelling due to accumulation of fluid from the vascular system ( edema ) can with pain and tenderness as well as the tendency to bruises associated. There is primarily no damage to the lymphatic system , but later this can be damaged by the increased vulnerability and inflammation of the fatty tissue, thus increasing the tendency to edema.

Lipedema occurs almost exclusively in women, after puberty, after pregnancy or during menopause . Hormonal changes and weight gain are suspected as the causes, as is a genetic predisposition .

Degrees of severity

  • Type I: Adipose tissue increase in the area of ​​the buttocks and hips (saddlebag phenomenon)
  • Type II: The lipedema extends to the knees, fat flaps in the area of ​​the inside of the knee
  • Type III: Lipedema extends from the hips to the ankles
  • Type IV: arms and legs are affected up to the wrists / ankles, with the exception of the feet and hands
  • Type V: Lipo lymphedema with increased storage of lymph in the back of the hand and foot as well as fingers and toes

Stages of skin changes

  • Stage 1: fine-knotted skin surface, colloquially " orange peel ",
  • Stage 2: coarse-knotted skin surface with larger dents, "mattress phenomenon",
  • Stage 3: large, deforming skin flaps and ridges
Very pronounced lipedema. The right leg is shown - the kneecap, on the right in the picture, is covered by a drooping lipedema. There is also severe obesity - the lower abdominal wall hangs down like a sack (in the picture above, covered by knitted clothing).

More symptoms

  • symmetrical, spongy swellings
  • Tenderness to touch and pressure
  • Tendency to form hematomas even after minor trauma
  • In advanced stages, skin is often cool and poorly supplied with blood
  • Depending on the stage, orange peel, mattress skin or large fat rags
  • due to the fat lobe disorders in gait, X-legs

Differential diagnostics

The visual and tactile findings (inspection and palpation) as well as the individual patient history serve the doctor as reliable points of reference when making a diagnosis. In contrast to lymphedema , Stemmer's sign is always negative; That is, with lipedema, a fold of skin can be lifted off over the toes or fingers.

In order to be able to diagnose lipedema with certainty, it must be excluded that the symptoms mentioned could have been caused by these diseases:

therapy

  • Compression therapy by consistently wearing flat-knitted compression stockings up to compression class IV, combined with exercise
  • Movement - "Movement, movement, movement" - swimming, also water aerobics (aqua aerobics) and other water sports such as aquacycling, aquafitness, aquaspinning, aquawalking, etc., fast walking, cycling
  • Weight loss (if overweight), change in diet, combined with exercise
  • Breath physiotherapy combined with exercise
  • functional, lymphological rehabilitation combined with exercise
  • Manual lymph drainage combined with exercise

If the above measures fail, surgical therapy via liposuction (may liposuction ) are carried out. However, this can lead to additional lymphedema by destroying the superficial lymph vessels .

Web links

literature

Individual evidence

  1. ↑ Alphabetical directory for the ICD-10-WHO version 2019, volume 3. German Institute for Medical Documentation and Information (DIMDI), Cologne 2019, p. 509
  2. ↑ lipohypertrophy
  3. ↑ Lia Lindmann: It is easier to live with lipedema . Humboldt, Hannover 2020, ISBN 978-3-8426-2941-7 , pp. 224 .
  4. ^ LE Wold, EA Hines, EV Allen: Lipedema of the legs; a syndrome characterized by fat legs and edema. In: Annals of internal medicine. Volume 34, Number 5, May 1951, pp. 1243-1250, PMID 14830102 .
  5. ^ S1 guideline on lipedema . AWMF registration number 037-012.
  6. ^ Roche Lexicon Medicine, 5th edition 2003, online here
  7. ↑ Manual lymphatic drainage ,