The Characteristics of Lipoedema

The most common form of mis-diagnosis is lipoedema misdiagnosed as lymphoedema, less common ones are a lipoedema for cellulite or obesity. This most common mis-diagnosis is a surprise since there are a range of differences between lipoedema and lymphoedema.

Symptoms Associated with Lipoedema

• Soft skin which may show a reduction in its elasticity.

• Dilated small superficial blood vessels (Spider veins).

• A tendency to bruise easily on the affected areas

• Tenderness of the skin on contact

• Discomfort with any form of external pressure

• Tension in the tissues

Other Events Which may be Occurring

• Progression of Fibrosis
  
  
  • The low number of macrophages compared to normal tissue mean the mechanisms for dealing with excessive protein accumulation (through proteolysis) is reduced, thus in the longer term there is a tendency for the formation of fibrosis between (and often within) the groups of fat cells (adiposites)

• Accumulation of protein rich fluids
  
  
  • In the instances where there is an excessive amount of subcutaneous fat, this may prevent the flow along even the larger lymph collectors by virtue of the greatly increased pressure on them.

• Other factors which may either precipitate (or worsen) the accumulation of fluids in the tissues of the limb include surgery, radiotherapy, tissue trauma (injury), an infection (inflammation), stress, high blood pressure or some other cardiovascular problem. If your lymphatic system is not properly formed or not functioning properly, then any change in the load of fluid and materials awaiting removal from the tissues or in the ability of the lymph system to transport them away will result in swelling.
  

Lipoedema or Cellulite?

• Differences - Cellulite is generally not painful while in the early stages of lipoedema, there are some subtle changes in the tissues (such as mild inflammatory processes and vascular disruption)which do not appear in the early stages of cellulite, although these do become observable as the cellulite develops.

• Similarities - in diet and process of aging may have a role to play in both instances, there are enough other tissue changes such as the accumulation of protein rich fluids and additional collagen deposition (associated with the lobules) which have been observed to suggest some form of similarity between the two conditions
  

Signs of the Early Stages

• Most of the symptoms and signs can be expected to show at puberty or slightly after, although there have been some instances where they have been observed much earlier than this.

• You should also be aware that there are many problems and signs of lipoedema other than the swelling or changes in the appearance of the limbs and of the surface tissues which comprise them.

• We sometimes focus on just the appearance aspect and not on the early signs. Some of you may not have really enlarged limbs, but may experience differences in how the legs feel. These indicators might include heaviness, tension, bursting pains etc. These may relate to the lipoedema or to the impact of the lipoedema or other events on the lymphatic system.

• Being well informed and knowing what to do (and what you should not do) and what questions to ask, will lead you to better understanding and control over your problem.

• Your lipoedematous limbs can be a life long problem, affecting the quality of your life, and your activities of daily living, but with the appropriate care, management and treatment the swelling and its associated problems can be reduced and often slowed significantly in terms of their progress.

• To a great extent however, the results of any treatment and management plan are dependant on your enthusiasm to carry out your tasks in the management side of the plan. They also depend on the establishment of a good communication with your treatment team and on a reasonable level of understanding of what happened to your lymphatic system and the tissues and what the various treatment and management strategies are trying to achieve.

What Happens as lipoedema progresses?

• Apart from the obvious changes in the appearance of the limbs (or other affected areas) there are subtle changes occurring in the tissues. These are associated with the delicate blood capillary structures (the end point of which is the leaking of more protein rich fluids) and with the even more delicate lymphatic uptake structures called lymphatic capillaries (the end point of which is a failure to properly take up the accumulated fluids). There is also a difficulty for the lymphatic collectors to pulsate easily thus reducing their transport ability.

• What these events mean, is that in lipoedema there are some significant problems with the lymphatic system as well as with the fatty tissue deposition, and it is clear they are related.

• In examining the appearance of the limbs as these changes in the tissue structure occur, there are external changes such as the increasing orange peel appearance of the skin which then develops a mattress like appearance and then eventually a lobulated appearance. These changes never occur in the feet or hands.