Lipoedema

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 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 in the tissues under the skin.

Patients generally present with very large lower limbs that are similar in shape and size on both sides. There is often a very distinctive pad of fat below the knees and many patients have a similar area on the thighs that can resemble a ‘saddle bag’ in appearance. 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 appear to be very loose and ‘floppy’ and are often very tender or painful to touch. Bruising occurs easily and spontaneously (without any apparent cause).

Other common features are painful knees, which tends to cause increased patient discomfort and disability. Some patients have flat feet and ‘knock knees’ which further affects mobility, posture and gait.

Due to the abnormal amount of fat under the skin, it can 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.

Lipoedema is a condition that is little understood and is often inaccurately diagnosed – or even misdiagnosed – by the medical profession. It is often mistaken for other conditions, in particular lymphoedema, as well as obesity. This happens most frequently when the lymphatic drainage becomes affected (for whatever reason) leading to a mixture of lipoedema and lymphoedema, known as lymphoedema secondary to lipoedema. In this instance, patients may be offered treatment for lymphoedema, but the underlying lipoedema can often be missed.

To try and explain the differences, it is helpful to compare the two conditions:

Main differences between Lipoedema and Lymphoedema

Lipoedema

  • Swelling of the lower limbs (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)
  • The swelling is usually soft and often comprises of loose, floppy, connective tissue and fat
  • There is often a pad of fat just under the knees and hips
  • 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
  • Pain in the joints, especially the knees, is often reported
  • Tenderness of the tissues can also be a feature
  • Limbs will often bruise easily and through no apparent cause
  • Risk of infection in affected areas is no greater than normal
  • The affected skin condition is usually soft and supple and not thickened
  • Generally affects females only
  • Losing weight will not improve the affected areas – but being overweight does not help
  • There is often a family history of the condition

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 June 2019
Next planned review June 2021

For more information, visit the dedicated lipoedema websites by clicking on the relevant logo below.