This information has been produced and verified by accepted experts in their field and reflects current practice. The information has been designed to assist you in managing your condition and is not intended to replace advice you may receive from your health care practitioner. If you or your healthcare practitioner would like further information, to ask any questions about this information, to provide us with any feedback or to find out what research underpins it, please contact the Lymphoedema Support Network on 020 7351 4480
What is lipoedema?
Lipoedema is a painful bi-lateral (and symmetrical) limb swelling mainly affecting the legs and thighs (but sometimes arms too) and is thought to occur as a result of an abnormal accumulation of fat cells (unrelated to diet) in the tissues under the skin.
Patients generally present with very large lower limbs that are similar in shape and size on both sides. The thighs, hips and buttocks often tend to be disproportionate (much larger) than the rest of the upper body – the waist is much smaller and the feet (and hands) are hardly ever affected.
The tissues of the limbs are also very tender or painful to touch.
Other common features are painful knees, which tends to cause increased patient discomfort and disability. Some patients have ‘knock knees’ which further affects mobility, posture and gait.
Due to the abnormal amount of fat under the skin, the tissues can often appear pale and feel cold to touch when compared to the unaffected parts of the body. Bulging fat can often lead to a ‘mattress effect’ on the skin, often described as Cellulite.
At present, we do not understand why lipoedema occurs, but a family history suggests a genetic basis. It seems to affect females exclusively and it is usually first noticed when there is a hormonal change (such as at puberty or pregnancy, or even the menopause) – or when there has been a period of general weight gain. Stabilising weight is thought to be very helpful in preventing progression of the disease.
Despite the name, oedema (a collection of fluid swelling) is not a feature of lipoedema. However, oedema may be present if the patient has other co-morbidities (such as venous or cardiac insufficiency, reduced mobility or general obesity). In such cases lipoedema is often inaccurately diagnosed – or even misdiagnosed – by the medical profession. It is often mistaken for other conditions, in particular obesity, as well as lymphoedema.
There is no cure for lipoedema but the progression can be minimised by implementing treatment as soon as possible. Getting a diagnosis is therefore essential and will enable women to have the best possible information to manage this often distressing condition.
Treatment
Assessment is vital to ensure a correct diagnosis is given and appropriate, realistic and achievable treatment instigated.
Treatment will include:
- Goal setting
- Compression
- Support with psychological issues
- Movement/Exercise
- Managing/stabilising weight (no diets)
- Education to self-manage the condition
To try and explain the differences between lipoedema and lymphoedema it is helpful to compare the two conditions :
Main differences between Lipoedema and Lymphoedema
Lipoedema
- Painful swelling of the lower limbs/tissues (and sometimes arms) which is bi-lateral and symmetrical (the same on both sides)
- General body shape is usually disproportionate (small torso, narrow waist and larger hips/thighs)
- Feet (or hands) are usually not affected (giving the appearance of a ‘bracelet effect’ at the ankles/wrists). There will be a negative Stemmers sign (inability to pick up a fold of skin at the base of a digit)
- Pitting (firm pressure on the skin leaving obvious indentations) of the skin is absent
- There is often a family history of the condition
- Generally affects females only
- May impact daily life, self-esteem and relationships
- Pain in the joints, especially the knees, is often reported over time
- Risk of infection in affected areas is no greater than normal
- The affected skin condition is usually soft and supple and not thickened
- Losing weight will not make a noticeable difference to the affected areas – but being overweight does not help
- Limbs will often bruise easily and through no apparent cause
- The affected connective tissue and fat may become soft, loose and floppy
- There is sometimes a pad of fat just under the knees and hips
Lymphoedema
- Swelling may be unequal on each side of body – one limb is often much larger than the other
- Feet are frequently affected and there will be a postive Stemmers sign (inability to pick up a fold of skin at the base of a digit)
- Pitting of the skin will be present – especially in the early stages of the condition
- No pain is felt if pressure is applied to the skin, but there is often a feeling of tightness in the tissues
- Limbs do not tend to bruise easily
- Increased risk of infection (Cellulitis) in affected, swollen areas
- Can affect females and males of any age
- The affected skin is often thickened and may have other features such as warty change or papillomatosis (cobble stone effect on the skin)
- Losing weight usually has a beneficial effect on the swelling
- In 20% there is a family history of the condition
Last reviewed October 2022
Next planned review October 2025
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