Olga Duclos, PA-C, in Johns Hopkins Department of Plastic and Reconstructive Surgery discusses the differences between lymphedema and lipedema, two conditions that are often confused with each other. Olga talks about how each condition is diagnosed, as well as the different treatment options.
Lymphoedema is a chronic and progressive disease in which accumulation of lymphatic fluid outside of its normal channels results in tissue swelling and inflammation. The lymphatic system runs through your body in Palo to your blood vessels. It is part of the immune system and helps to fight against infections. When the lymphatic system does not work properly, it is unable to drain the lymphatic fluid sufficiently. This leads to collection of fluid in the affected area and causes swelling. We have two different causes of lymphoedema. A primary and a secondary. The primary lymphoedema usually occurs due to a functional and structural abnormalities of the channels. It can also occur as early as birth. The secondary lymphoedema develops after disruption of the lymphatic channels. Most commonly due to having undergone surgical procedure or trauma, your provider may gather important medical and surgical history to determine the risk factors. They will also perform physical examination. Imaging may consist of lympho syt gray or lymphatic mapping shown in this picture. Imaging allows the doctor to see if the lymphatic system function is appropriate or if there is a backflow of failure of the flow. A lack of the normal flow indicates diagnosis of lymphoedema. Conservative treatment includes skin care and exercise, compression, garment or lymphatic drainage surgical treatment offered here at Johns Hopkins includes lymphogenous bypass, lymph node transfer liposuction or debulking of the excess tissue lymphoedema and lipedema are often confused with one another due to their similarities. Lymphoedema is a blockage of lymphatic vessels. While lipedema is a build up of adipose tissue. Lima appears symmetrical in shape and size affecting the legs and sometimes the arms, the body above the hips, hands and feet usually remains unaffected. The cause of lipedema is unknown. A diagnosis can be difficult. It mainly occurs in women often appearing around times of hormonal change and weight gain. The diagnosis of lipedema includes clinical and family history. There is no testing required. Usually the signs of lipedema include excess fat, build up in the hips, thighs and lower legs. Affected area often feels tender to the touch, heavy skin is uneven and bumpy. Patients have shown little to no improvement in volume of the affected area while taking diuretics or lymphatic pump decompression. The treatment includes diet, weight loss, exercise, skin care or compression. Surgical management usually includes liposuction. In summary, lymphoedema is usually due to a poor lymphatic drainage, maybe a family history or result from damage to the lymphatic system due to cancer, trauma or radiation. It can impact legs, arms, trunks, genitalia or head and neck. It frequently impacts one side. Although it may be bilateral, it affects both women and men, swelling of the limbs affects hand and feet. It's usually not related to hormonal imbalance versus lipedema. The cause is still unknown, possibly genetic. It results in excessive build up of the fat under the skin, usually involves lower limbs but can also occur in arms. It usually is bilateral, affects mostly women, swelling, stops at ankles and it may be estrogen related often a family history of lipedema is present as well.
