What is lipedema?

Lipedema is a hereditary disorder of fatty tissue distribution. It is the result of an increased number of fat cells that are distributed in an irregular way beneath the skin. Since lipedema occurs almost exclusively in women, affecting up to 11%, experts assume it is due to hormonal causes. The few men who develop lipedema often have liver damage.

    Signs and symptoms

    One of the signs of lipedema is to do a Stemmer’s test. If you can pinch a skin fold at the base of the toe or a finger, then this is a negative Stemmer’s sign. In lipedema, the “Stemmer’s sign” will always be negative. In lymphedema, this is not possible (Stemmer’s sign is positive). Other signs of lipedema are a tendency to develop spider veins, bruises or increased swelling of the calf in the second half of the day.

    In contrast to lymphedema, lipedema is always symmetrical.  Lipedema is painful to pressure and touch. In the advanced stages, even wearing tight clothing is painful. 

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      Clinical signs of lipedema:

      • Negative Stemmer’s sign
      • Symmetrical swelling
      • Pain from touch and pressure
      • Bursting pain
      • Often spider veins over the outside of the thigh
      • Susceptibility to bruising
      • Familial history
      • Skin is soft, nodular and exhibits typical pitting
      • In a few cases, the arms are also affected 

      Risk factors and causes

      Almost only women and girls are affected by lipedema. Therefore, experts suspect hormonal causes. Lipedema begins or worsens at puberty, during pregnancy, following gynecologic surgery or during the time of menopause. Furthermore, susceptibility to lipedema appears to be genetic.


      Exercise and a healthy diet help during the early stages of lipedema. Patients should exercise about three times a week for at least 45 minutes at each session. It is essential to wear compression garments during fitness; this prevents swelling, as the improved circulation presses more water into the tissues.

      There are wide-ranging treatment methods for existing lipedema ranging from manual lymph drainage, the use of compression, exercise and liposuction.

      Tips for everyday living with lipedema

      Lipedema is a chronic disease. Even with medical therapy, your daily routine will determine how well you can cope with living with edema. Dieting and exercise will not reduce the fat involved in lipedema, but it’s still vital to do those things because they will help you lose weight from non-lipedema fat, and it reduces inflammation.

      Manual Lymph Drainage

      This form of massage uses gentle, rhythmic pumping movements to stimulate the flow of lymph around blocked areas to healthy vessels, where it can drain into the venous system.

      • exercise
      • clothing
      • balanced diet
      • drugs
      • skin care

      Exercise is advisable, but only if you wear your compression garments or stockings. Otherwise, the circumference of your legs could still increase further without the use of compression. The following exercises are particularly recommended:

      1. Walking
      2. Hiking
      3. Aerobics

      Also recommended are aqua-jogging and swimming, which you can do without compression, because the water pressure acts like compression.

      Make sure you wear loose-fitting clothes and flat, comfortable shoes. Do not wear any tight belts or bras that would constrict movement.

      The fat pads seen in lipedema are not caused by being overweight, so dieting will not make lipedema go away. Nevertheless, losing weight and staying active (with compression) has positive effects. You should avoid putting on weight if possible.

      Lipedema does not respond to pills or ointments.

      Hygiene is especially important for patients with edema. Always clean and care for your skin with pH-neutral care products. Do not use deodorants over edematous areas.

      How is lipedema treated?

      While diet and exercise are helpful, compression therapy achieves beneficial results. It ensures that the edema does not develop further.

      Compression garments reduce lipedema or at least sustain it where it is. In stage 1, seamless, round-knit compression stockings in 15-20, 20-30, or 30-40 mmHg can often be used. But experts recommend flat-knit compression care in most cases. The stockings should preferably be worn every day, but at least three days a week (during exercise as well). Your doctor or clinician will advise you on what’s best for you. Patients in stage 2 use flat–knit compression garments (which are seamed garments). In stage 3, complex physical decongestion therapy is applied similarly to lymphedema. This starts in phase 1 with manual lymphatic drainage followed by the application of compression bandaging. This is followed by the maintenance phase and the wearing of compression garments, specifically flat-knit garments. They offer optimum pressure stability because the material is less elastic.

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