Lipedema and lymphedema, two diseases with similar symptoms but different treatments

Lipedema and lymphedema are two conditions that cause swelling in the arms or legs and, due to their similar symptoms, can be confused. However, their origins and treatments are very different, so it is essential to distinguish between them.

Lipedema is a chronic disorder of fat distribution. It is characterised by the symmetrical accumulation of painful fatty tissue in the hips, thighs and legs, and in some cases also the arms, but not the hands or feet. It usually appears or worsens during periods of hormonal change such as puberty, pregnancy or menopause. Its symptoms include pain when touched, frequent bruising, heaviness, fatigue, and soft skin with nodules. This fat does not respond to diet or exercise, which causes frustration in patients.

High resolution image. This link will open using lightbox, there may be a context switchDr. Pablo Gallo GonzálezLymphedema, on the other hand, is a disorder of the lymphatic system that occurs when the vessels are damaged, malformed, or blocked. It can be primary (from birth) or secondary to cancer surgery, radiotherapy, infections, or trauma. It manifests as persistent, usually asymmetrical swelling, which may include the feet or hands, as well as skin tightness, progressive hardening of the skin, and recurrent episodes of skin infections.

Dr Pablo Gallo González, head of the Angiology and Vascular Surgery Unit at Ruber Internacional Hospital, stresses the importance of not confusing the two diseases.
‘Lipedema is caused by an excess of painful, symmetrical fat that does not affect the hands and feet; lymphedema, on the other hand, is an accumulation of lymph that also tends to affect these areas and causes more tension than pain.’
Key differences in consultation

The diagnosis is made through a detailed medical history, physical examination and, if necessary, imaging tests such as Doppler ultrasound, lymphoscintigraphy or magnetic resonance imaging.

In this regard, Dr Gallo explains the most common signs:

• Stemmer's sign (performed by pinching the skin on the back of the toes) is negative in lipedema and positive in lymphedema.

• Distribution: symmetrical in lipedema, asymmetrical in lymphedema.

• Leg elevation: barely improves lipedema, but does reduce swelling in the early stages of lymphedema.
‘Early identification of these conditions prevents complications such as fibrosis or lipo-lymphedema, which combines both,’ warns the specialist.

The therapeutic approach also differs:

• Lipedema: physiotherapy, compression therapy, adapted exercise and, in advanced cases, selective liposuction.

• Lymphedema: manual lymphatic drainage, specific compression garments and, in certain cases, microsurgery or lymph node transplantation.

Despite their differences, both disorders require compression therapy and adapted physical activity to improve quality of life.

‘Treatment must be personalised; in lipoedema, we seek to reduce painful fat and improve mobility; in lymphedema, we seek to control swelling, prevent infections and preserve limb function,’ says Dr Gallo.

The role of information and prevention

Lack of knowledge about these diseases means that many patients arrive late for their consultation or after having tried ineffective treatments.

‘Getting informed, receiving an accurate diagnosis and seeing a lymphology specialist are essential steps. Early detection completely changes the progression and quality of life of patients,’ concludes the head of the Angiology and Vascular Surgery Department at Ruber Internacional Hospital.