What is Lipoedema

• Lipoedema, cellulite, lipodystrophia and sometimes obesity are some of the names commonly used by lay people to describe this condition.

• Lipoedema is a chronic disorder (some might call it a disease) of fat metabolism and distribution which is characterized by its symmetrical distribution normally between the top of the pelvis and the ankles.

• No one is particularly clear about the underlying causes and the incidence or prevalence of lipoedemas. Some studies have indicated however that the incidence may be between 10 and 15% of the female population.

• One thing we do know is that the condition mainly affects women and then mainly the legs. This is not to say it does not also appear in the arms, in fact one clinic reported that about 30% of their lipoedmea patients had the problem in their arm as well as their legs. However there are a few men with the condition and in these cases it seems to be related to reductions in male hormones or to problems with liver function.
  

Our Subcutaneous Fat

• Every person has some greater or lesser amount of subcutaneous fat. It's a necessary insulator, a cushion and an energy reserve when needed. This fat is found all over our body just under our skin but above the muscles. It can become predominant in the buttock and tummy areas of women. There is also fat within our abdominal cavity and its needed to hold together our intestines and other structures such as the kidneys. Its normal for women to have between 25 to 35% of their body weight present as fat.

• In cases of lipoedema however, there is an excessive deposition (or a reduced turnover) if fats usually in the lower limbs and thighs. Remember this is genetic and you are not to blame, although if you are also a little overweight due to dietary problems then you will need to accept some responsibility for this component.
  

Lipoedema and Obesity

• It does not appear that lipoedema is caused by over-eating, in fact most attempts at dieting will not reverse lipoedema, although it may slow its progress. Some patients are unfortunately diagnosed as being obese when in fact they have a lipoedema.

• However, if there is obesity (as determined by enhanced deposition of subcutaneous fats around the trunk and other areas not normally affected by lipoedema) then dietary advice for the obesity component is appropriate and you will need to accept some responsibility for managing this component.

• The fat which is a characteristic of lipoedema is not the same as the fat which occurs in obesity. Two of the major obvious differences are its location and the fact that it most often does not respond very well to diets or other strategies which would normally result in weight loss through a reduction in body fat. One not so obvious difference between lipoedema and obesity is a finding that the blood capillaries show an increased fragility in lipoedema and thus a tendency to leak more proteins from them.

• Because of the proteins, additional fluids are attracted. One of the other documented problems is that whatever appears in the tissues either from the vascular system or as a by product of cellular metabolism it has trouble leaving the tissue due to their poor uptake from the tissue spaces by the lymphatic capillaries. What this basically means is that the formation of lymph is reduced and that this fluid remains in the tissues.
  

How common are lipoedemas

• A Family History? There are a number of studies underway to identify the genes associated with the problem of abnormal subcutaneous fat tissue deposition as it occurs in lipoedema and similar conditions. There are also studies to investigate the genes associated with blood and lymph vessel growth and how they can be switched on and off. An aim of some of these studies is to try to trigger switches to again be turn on so that new lymph vessels can again be formed and growth and handle the larger lymph load that occurs in later stage lipoedemas. Some other studies are investigating aspects of tissue engineering which may also allow us to grow new lymph vessels and perhaps lymph nodes.

• One study claims an incidence of 11% of the female population and notes that there seems to be an increase incidence after trauma to the head and after pituitary adenoma surgery. Another study estimates 15%. It is clear however, that this (as with lymphoedema) may be an under-diagnosed condition and that we are still a long way from knowing the true prevalence.
  

Progression of Lipoedema

• Generally the first signs of the problem begin to become observable at puberty and then usually in the hip area where fatty pads are observable on the outer thigh area. From here, as it progresses, it generally extends towards the knees (again where fatty pads form on the inside of them) and then to the ankles. The feet are never involved in the fatty tissue accumulation, but may show signs of fluid accumulation.
  

Types of lipoedema

• Some groups have proposed a number of types of lipoedema which are partitioned on the basis mainly of the location of the problem.

• Type 1 is when lipoedema is confined to the buttocks and outer thighs

• Type 2 is when lipoedema extends to the knees and fat pads are observable here on the inner knee area.

• Type 3 is when lipoedema is observable as far down as the ankles.

• Type 4 is when the arms (which is uncommon) are involved and

• Type 5 is when the arms and legs and the lymphatic system is involved leading to a lipo-lymphoedema.

• Type 6 is when the lipoedema is linked with obesity and the whole body is involved
  

Stages of Lipoedema

• In terms of staging, the most commonly used criteria's relate to the skin and changes it undergoes.

• Stage 1 involves a normal skin surface but which appears like orange peel (small nodules appear) when gently squeezed

• Stage 2 is when the skin surface is uneven to the naked eye and there is a mattress like appearance with largish nodules and indentations

• Stage 3 is when there are large skin flaps and lobules which can often be deformed.

• In the mid and later stages there are often increased leakages of protein rich fluid from the blood vessels (due to their fragility) and thus the accumulation of these fluids in the tissues. This is especially predominant in the afternoons and evenings leading to increased pain and tension.

• The constant high load of fluids leaking from the vascular system may cause the lymphatic system to fail. Added tot his is the external pressure that the fatty subcutaneous tissues and fibrous tissues exert on the delicate lymphatics. Both these mechanisms lead to the failure of the lymphatic system. Once the lymphatic system fails, excessive protein rich fluids accumulate in the tissues. This stage is more correctly called lipo-lymphoedema.

• If the lymphatic system has failed for another reason (ie surgery/radiotherapy or some genetic reason – primary lymphoedemas) and there is only some mild lipoedema then the condition is more correctly called lympho-lipoedema.