pathology: lipedema

yogabook / pathologie / lipedema

lipedema / rider’s trousers syndrome / suave trousers syndrome / columnar leg

Definition of

Chronic progressive pathological increase in subcutaneous fatty tissue due to a fat distribution disorder, occurring symmetrically, usually in the lower extremities and buttocks, sometimes also in the upper extremities. The trunk, hands and feet are not affected, in very rare cases the abdomen. The disorder usually occurs between the ages of 20 and 30, in Germany between half a million and one million women are probably affected, men are only very rarely affected. If lipoedema develops in them, an endocrinological disorder is always detectable, for example in the context of liver cirrhosis or a lack of HGH or testosterone, as well as hormone therapy for prostate cancer. Endocrinological changes such as puberty or pregnancy, and sometimes also the menopause, can have a triggering effect. In addition to the increased formation of fatty tissue (hypertrophy and hyperplasia of the fat cells), there is also increased water retention (water oedema), as the capillaries become more permeable. This also causes an increased tendency to hematomas. As long as the disorder does not regularly cause discomfort in the form of pressure or pain, it is not considered a disease. It often takes years before a diagnosis is made, partly because the disorder is mistaken for obesity. However, apart from the distribution pattern, lipoedema can be distinguished from obesity, which lacks sensitivity to touch, at the latest when the skin becomes more sensitive to touch. Attempts at dieting and endurance sports do not help against fat storage, but poor or excessive nutrition and a lack of endurance sports can increase the progression and severity. Early intervention can delay progression. It is not uncommon for lipoedema to be accompanied by obesity, the fat deposits of which also affect other areas of the body. In severe cases, the fatty tissue can disrupt the lymphatic drainage, resulting in secondary lymphoedema. In contrast to lymphoedema, elevation of the limb does not improve the situation. Stemmer’s sign can also be used to differentiate between the two disorders. The specialists responsible are usually dermatologists, phlebologists or lymphologists. The disorder can be divided into stages:

  1. Orange peel: uniformly thickened, orange-like skin with increased volume
  2. uneven, mostly wavy skin surface with already significantly larger volume
  3. Coarse nodular skin surface, deformed by the formation of partly overhanging lobes, with massively increased volume,

Cause

  1. unknown
  2. Trigger: hormonal changes such as pregnancy or puberty
  3. genetic disposition

Diagnosis

  1. clinical. Laboratory and imaging tests do not show the disorder
  2. A strictly adhered to failed diet with no effect on fat storage can be considered diagnostic
  3. Tests and signs:Stemmer sign

Symptoms

  1. Feeling of tension or pressure
  2. Increased sensation of touch to painful pressure on the skin
  3. Increased tendency to hematomas
  4. Feeling of heavy, swollen legs
  5. Orange peel skin, wavy skin, nodules under the skin
  6. columnar silhouette of the legs, possible development of bulges on the inner thighs

Complications

  1. Tendency to increased wear and tear, especially in the joints of the lower extremities, due to higher body weight
  2. Changes in the gait pattern, manifestation of joint malpositions
  3. Lipo-lymphedema (manifestation of secondary lymphedema)
  4. Increased risk of erysipelas
  5. Psychological stress, reduced self-esteem due to the disproportion, tendency to depression, eating disorder

Therapy

  1. No known causal therapy, symptomatic
  2. Compression therapy (using equipment or compression garments), in advanced stages also lymphatic drainage
  3. Sports and exercise therapy, also to prevent complications in the musculoskeletal system
  4. Sports in the water because of the pressure
  5. Endurance sports with compression garments
  6. Liposuction: surgical liposuction (ultrasound, water jet or vibrations remove the fat, which is then sucked out endoscopically) can improve the symptoms permanently, often for years. Possible complications: Post-operative bleeding, wound infection. Depending on the condition before liposuction, skin bags („too much“ skin) may remain
  7. Nutritional therapy for weight control
  8. Shock wave therapy, intermittent pneumatic compression

DD

  1. Lymphoedema
  2. Obesity