While walking down the street or in other crowded places, you might have seen someone with saggy-looking skin, usually on their lower limbs. Have you ever wondered what this condition is called, or what causes it? In most cases, it is likely to be lipedema.

Lipedema is a chronic condition that results in the accumulation of fat that eventually results in a disproportionate distribution. It is characterised by a symmetrical swelling either in the legs, thighs, buttocks, or sometimes in the arms.

It is almost seen exclusively among women, with only very rare cases affecting men. Unfortunately for some, lipedema may take a toll on patients’ daily life, from their physical health to their mental wellbeing.

As a condition that may develop over time, doctors or dermatologists classify lipedema in different stages depending on its development:

Stage 1

The patient’s skin may appear to be normal and smooth to the touch. However, the skin will have nodules of enlarged fat present underneath, which can be felt during an examination. Patients may experience some pain and easy bruising upon injury.

Stage 2

The patient’s skin often looks uneven and the skin may become dimpled, have indentations, and develop what looks like a mattress-like pattern. The amount of fat is also higher.

Stage 3

Patients may develop large extensions of skin and fat. These visible, large folds can be seen protruding from the limbs owing to inflammation and thickening of tissues which, as a result, can cause the legs to look columnar.

This subsequently causes a loss of elasticity and, eventually, reduced blood and lymph flow out of the fatty tissue, stimulating it to grow even more. Patients’ mobility and balance may be affected since these protrusions of fat can exert pressure on their joints.

Stage 4

This stage is when lipedema and lymphedema are both present in the body. Lymphedema is described as the buildup of fluid in the body’s tissues from a damaged lymphatic system, and often develops when lipedema causes a buildup of fat cells that interferes with the patient’s lymphatic system.

Unlike those with lipedema, those with lymphoedema will notice that their feet or hands are also affected, and/or the degree of swelling is not the same; usually one limb is more swollen than the other.

Types of lipedema

Type I: Fat is between the navel and the hips, and often covers the pelvis and buttocks.
Type II: Fat begins at the pelvis and continues down to the knees.
Type III: Fat begins at the pelvis and continues down to the ankles.
Type IV: Fat spreads from the shoulders down to the wrists.
Type V: Fat is predominantly on the calves.

Though rare, it is reported that some may have a combination of types.

Why does it happen?

The causes of lipedema remain unknown but are widely attributed to genetic causes and/or hormonal changes. The condition usually begins or worsens in someone with a family history of the disease, or when there are changes in hormonal levels, such as during puberty, pregnancy or menopause.

While lipedema may seem more apparent in patients who are of heavier weight, it doesn’t only affect overweight or obese patients, and can also affect those who are of a healthy weight.

Symptoms

Patients will likely experience at least one of these:

• symmetrically swollen legs and arms, with feet and hands usually unaffected;
• pain, discomfort, heaviness or tenderness in affected areas;
• dimpled legs or an “orange-peel” texture where fat may seen bulging at the knees;
• difficulty walking owing to changes in leg shape from fat accumulation;
• swelling that may worsen in the afternoon, evening, after an activity, or in hot weather;
• easy bruising and/or touch sensitivity in affected areas.

Notably, those with lipedema may face restrictions in mobility or taking part in physical activities, which could lead them to develop low self-esteem and other mental issues such as depression, anxiety, embarrassment and insecurities.

In addition, options for clothes that fit right or look good are also limited due to their disproportionate body shape.

Treatment options

While there has yet to be an established treatment plan for lipedema, steps can be taken to reduce symptoms and improve patients’ quality of life.

The fatty buildup may not respond well to calorie restriction or dieting; nevertheless, dietary changes could help, since it is possible to be overweight or obese in addition to having lipedema. An anti-inflammatory diet may be particularly beneficial.

Since walking may be a challenge for some, low-impact exercises such as swimming or water aerobics could help increase mobility and enhance blood circulation. As a result, pain and inflammation may also be reduced.

Gentle yoga can also be practised, which could help build muscle strength and improve flexibility while helping one’s mood. Massages have been known to improve mobility as it moves the fluids from the affected area to be equally distributed to the other parts of the body.

Compression – the use of stretchy bandages or tight forms of clothing – may increase tissue pressure in the legs and reduce the risk of more fluid buildup in the limbs.

Finally, there is the option of liposuction, an invasive surgical procedure that removes the fat from affected areas. This appears to be highly effective when all other conservative treatments fail to respond, though several sessions may be needed depending on the amount of fat present.

Conclusion

In Malaysia, lipedema is still misdiagnosed and mistreated, which can negatively impact patients’ mental health. By understanding and spreading knowledge on this condition, it is hoped that misconceptions and stigma surrounding lipedema can be reduced, allowing those with this condition to feel more confident and accepted.

This article was written by DOC2US, a mobile application that allows you to talk to a doctor or any healthcare professionals via text chat at any time and from anywhere.