Adnkronos (Adnkronos) – "Until recently, lipedema was thought to be a chronic, inflammatory disease of adipose tissue, characterized by an abnormal and symmetrical accumulation of fat, especially on the legs, thighs, and hips. It affects almost exclusively women and is not related to poor diet or obesity, although it can coexist with them.
To date, it has been concluded that lipedema is not simply a disease of adipose tissue, but a complex, systemic condition involving multiple systems and tissues. The connective tissue and microcirculation are most affected, with chronic, low-grade inflammation and damage to the small vessels. The lymphatic and venous systems are also affected, with alterations in drainage and venous return that can cause swelling and heaviness.
This is what Dr. Marzia Bernardi, an aesthetic physician specializing in the diagnosis and treatment of lipedema, told Adnkronos Salute.
"It's a genetic disorder," Bernardi explains, "in which hormonal changes can play a key role in 'activating' the disease. The constant inflammation typical of lipedema could, in some cases, cause insulin resistance, gestational diabetes, the activation of autoimmune diseases, or problems with the gut microbiome."
The main symptoms include pain and tenderness, easy bruising, telangiectasia, heaviness and tiredness in the lower limbs, cramps, tingling or a feeling of cold, difficulty sleeping, subcutaneous nodules, sock marks, and a disproportion between the upper body and the lower limbs, with characteristic accumulations of fat.
It is believed that in Italy approximately 10-11% of the female population suffers from lipedema, worldwide 1 in 9 patients" he adds.
The difference between obesity and lymphedema must also be clarified. "These conditions are very often confused, resulting in a delayed diagnosis of lipedema," observes Bernardi. "While lipedema is a genetic condition, obesity is often linked to an unhealthy lifestyle. It should also be remembered that lipedema does not improve with diet and physical activity, unless specifically prescribed, whereas obesity does. In obesity, adipose tissue is distributed throughout the body and is painless, while in lipedema, it has specific localizations and is painful both to the touch and spontaneously." In the case of lymphedema, however, "we have an accumulation of lymphatic fluid due to a blockage or malfunction of the lymphatic vessels. It should be remembered that lipedema is always bilateral, while lymphedema is unilateral."
The diagnosis is currently clinical. "During the examination, we look for signs and symptoms typical of the condition. There are no instrumental tests, genetic tests, or laboratory tests that can diagnose lipedema. The most common mistakes," says Bernardi, "are confusing the condition with cellulite, adiposity, and lymphedema, and failing to make a timely diagnosis." According to the specialist, "we are dealing with a chronic condition for which there is no definitive cure, but there are therapies that aim to treat the symptoms and prevent the condition from progressing. The approach is always multidisciplinary and involves the collaboration of a doctor, physiotherapist, nutritionist, personal trainer/kinesiologist, and psychologist. The primary goals are to reduce inflammation and 'break down' the fibrosis that causes the formation of the nodules typical of lipedema."
Regarding surgery, "currently, there are two schools of thought: one that maintains that it's best to operate on the early stages to prevent further progression, and another that maintains that it should be reserved for the most severe cases where there is obvious difficulty walking. Each case must certainly be evaluated individually, and regardless, surgery should always be followed by conservative maintenance therapy." For Bernardi, "lipedema is still an under-recognized condition." One of the "main psychological problems these patients face is that they aren't believed in their presentation of symptoms and their objective difficulty losing weight. This has led many of them to abandon treatment and their symptoms worsen. The National Health Service still struggles to recognize the condition, and unfortunately, all treatments are paid for by the patients. We hope that over the years, this will change to the benefit of patients' well-being," he concludes.
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