June has been designated as Lipedema Awareness Month, a disease that affects millions of people around the world. The goal of the Brazilian Society of Vascular and Vascular Surgery – São Paulo Regional (SBACV-SP) is to spread early diagnosis as well as ensure adequate treatment for all those facing this condition.
Lipedema: the disease is divided according to the affected areas
There is a classification indicating the progression and severity of lipedema
- level 1: The surface of the skin is normal, there is an excess of fat in the subcutaneous tissue, and there are subcutaneous fat nodules that can be observed.
- The second phase: The skin is irregular, a little looser than expected for age and the appearance of cellulite, and the nodules that we can feel are larger.
- Stage 3: The skin is noticeably more elastic, with skin folds. This can cause difficulty walking and moving around. In addition to nodules, we can also feel areas of fibrosis, which are similar to scars under the skin caused by chronic inflammation.
- Stage 4: All of the changes described are in stage 3, in addition to lymphatic system involvement. Lymphedema (involvement of lymph vessels) can occur at any stage, but is most often found at stage 4, called lymphedema.
In addition, care is also highlighted with food. It is important to note that restrictive diets do not have a significant effect on reducing fat accumulation in lipedema and may exacerbate body asymmetry. However, it is highly recommended that patients maintain a healthy weight. While there are reports of some so-called “anti-inflammatory” diets providing better symptom control, there is not enough scientific evidence to recommend them.
Diagnosis
The diagnosis of the disease is clinical, and it is up to the specialist to detect the suspicion. There are no tests that indicate the presence of the disease before it is noticed clinically. Tests (ultrasound, CT, lymphatic scintigraphy, bioimpedance) are used to diagnose cases where there is a suspicion of an association between the problems,” he tells the vascular surgeon.
Although there is no cure, there are treatment options available to relieve symptoms, prevent worsening, and improve quality of life. One of the recommendations is the use of compression stockings, a suggestion that, according to Mauro Andrade, may be received with reluctance and some patients resist using them due to previous unsuccessful trials due to inadequate prescriptions.
“The stockings commonly used to treat lower extremity edema (in non-advanced venous disease, for example) are circular knit stockings. For patients with lipedema, the recommended use – along with medical follow-up – is elastic stockings with stretch Low (less elastic), which is obtained when the manufacturing material is knit flat. It is a type of tissue that is less stretchy, more robust and comfortable and adapts better to the shape of the affected limb, “explains the doctor.
Lipedema has no cure
Because the patient will live with the condition for the rest of their life, medical follow-up is essential. It is carried out in a multidisciplinary way, that is, with the help of specialists from different areas, the most recommended are vascular surgeons, dermatologists, physiotherapists and nutritionists.
According to Fabio Rossi, vascular surgeon and President of the Brazilian Society of Vascular Medicine and Vascular Surgery – São Paulo Regional (SBACV-SP), lipedema is a very common disease, affecting one in ten women. Depending on its severity, this condition can have a significant impact on quality of life: “The first step in treatment is to seek a vascular specialist or vascular surgeon, who will assess the differential diagnosis in cases of symptoms such as pain and swelling in disease-sensitization and appropriate guidance may also be recommended, and complementary tests such as vascular Doppler, lymphatic imaging, body fat measurement and, in some cases, MRI.”
The head of SBACV-SP also explains that in some cases where clinical treatment is not sufficient, and other causes of disease are ignored, which still threaten the quality of life, liposuction techniques may be indicated. However, complication rates and long-term outcomes are still unknown: “These cases must be evaluated by a multidisciplinary team, and the best treatment strategy must be determined in a combined way,” explains Fabio Rossi.
