Lipoedema and lymphoedema

Lipedema and Lymphedema: Two Different Causes of Swollen Legs

Both lipedema and lymphedema are chronic conditions that cause an increase in leg volume, but they are biologically very different and therefore require very different treatment strategies. It is important to get an accurate diagnosis - especially if your swelling cannot be explained by varicose veins or lifestyle factors.

Lipedema in the left leg (left in the image) and lymphedema in both legs (right).

What is Lipedema?

Lipedema is a chronic fat distribution disorder characterized by an abnormal accumulation of adipose tissue - almost exclusively in women. The condition is often triggered in connection with hormonal changes (puberty, pregnancy, menopause).

• Symmetrical distribution: Typically affects both legs to a similar degree, and often the arms as well.
• Often stops at ankles and wrists: A "cuff phenomenon" is often seen, with the feet and hands relatively spared. This is a typical feature, not a mandatory single criterion.
• Pain upon pressure: A key symptom is that the tissue is painful to the touch and easily bruises.
• Resistant to weight loss: The typical fat deposits do not disappear with diet or exercise.

What is Lymphedema?

Lymphedema, on the other hand, is a disorder of fluid transport: the lymphatic system cannot drain fluid effectively, and it accumulates in the tissue.

• Primary lymphedema: Congenital impaired function of the lymphatic vessels.
• Secondary lymphedema: Occurs after injury, infection, radiation, or surgery - for example, after removal of lymph nodes in connection with cancer treatment.
• Often involves feet and toes: Unlike lipedema, the swelling often affects the entire limb, including the toes and fingers.
• Typically not painful in the early stages; late pain may occur due to tension and complications.

The Difference in Brief

Characteristic	Lipedema (fat disorder)	Lymphedema (fluid disorder)
Cause	Abnormal fat accumulation, hormonally triggered	Impaired lymphatic drainage, congenital or acquired
Symmetry	Typically symmetrical	Often unilateral or asymmetrical
Feet/Hands	Often relatively spared - typically stops at ankle/wrist	Often involved
Pain	Painful upon pressure, bruises easily	Usually painless in early stage
Response to weight loss	Fat deposits remain	Swelling is not reduced by weight loss

Lipo-lymphedema: The Combination Condition

If lipedema becomes advanced, the large adipose tissue can compress the lymphatic vessels and inhibit their function. The result is a combined condition called lipo-lymphedema, where both mechanisms contribute to the swelling. The condition requires a combined treatment strategy.

Connection with Varicose Veins

Many patients are referred to the clinic with swollen legs suspected of having varicose veins, but where the underlying causes are actually lipedema or lymphedema. It is crucial to distinguish because:

• Varicose veins (venous insufficiency) are treated with laser treatment (EVLT) or phlebectomy.
• Lipedema is not treated with vein surgery - it can even worsen the condition.
• Lymphedema is treated with manual lymphatic drainage, compression bandaging, and custom-made stockings.

A duplex ultrasound examination can clarify whether there is venous insufficiency, and a clinical assessment of the distribution pattern, pain, and skin condition determines whether it is lipedema or lymphedema.

Treatment Principles

Lipedema:

• Custom-made flat-knitted compression stockings (class 2-3)
• Manual lymphatic drainage for relief
• Movement in water (relieves pressure)
• Liposuction in selected patients in late stages
• Pain management and anti-inflammatory diet

Lymphedema:

• Complete decongestive therapy (CDT): manual lymphatic drainage, bandaging, skin care, and movement
• Daily use of custom-made compression stockings
• Early diagnosis can allow earlier support and follow-up. It does not stop documented progression and does not guarantee that skin changes, ulceration or infection can be prevented

When Should You Seek Medical Attention?

Seek medical evaluation if you experience:

• Persistent, symmetrical swelling that does not subside overnight
• Pain or tenderness in fat tissue upon pressure
• Asymmetrical swelling that includes the foot and toes
• Tightness, hardened skin, or repeated skin infections in a swollen leg
• Suspicion that your "varicose veins" are due to another condition

An early and correct diagnosis makes it possible to start treatment and follow-up earlier in the course. The course varies from person to person, and neither early diagnosis nor treatment can guarantee that the condition will not progress.