Lipedema refers to an abnormal accumulation of fat and edema fluid in the lower extremities which may be confused with lymphedema.


Clinical features seen with lipedema:

(1) the patient is typically obese

(2) almost all patients are women

(3) some patients have a family history of lipedema

(4) presence of easy bruisability

(5) presence of pain and tenderness

(6) normal skin texture and consistency with a negative Kaposi-Stemmer test

(7) affects both legs but spares the feet

(8) no or minimal pitting edema

(9) persists despite elevation of the feet


Kaposi-Stemmer test is performed by trying to pinch a fold of skin at the base of the second toe. The skin cannot be pinched (positive) in lymphedema because the skin is thick and fibrotic. It can be pinched in lipedema (negative test).


Findings suggesting another diagnosis:

(1) occurrence in a male

(2) fibrotic (brawny) skin texture

(3) unilateral leg swelling


Findings which may be seen with another disease or with another disorder superimposed on lipedema:

(1) involvement of feet: In severe, longstanding disease a patient with lipedema may develop foot swelling, which is termed lipedema-lymphedema syndrome.

(2) pitting edema


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