Lipoedema vs lymphedema

Underlying causes and mechanisms, affected areas, profile and number of people affected, associated pathological signs, diagnostic tools, management strategies, etc. There are many points that differentiate these two pathologies, which are very often confused.

In both cases: legs that swell...

It is a fact: lipoedema is very often confused with primary lymphedema of the lower limbs. The cause? One and the same main symptom: a very significant volume gain in the legs which start to swell. However, there are specificities specific to each of these two pathologies of the lower limbs...

Due to an abnormal distribution of fatty tissue with still mysterious causes, lipoedema almost always affects both legs, mainly in the thighs, but its progression spares the feet. Generated by an abnormal accumulation of lymph that has not yet been elucidated in less than one in 6,000 people, lymphedema mainly attacks the feet, then the ankles and calves... but rarely on both legs at the same time.

… but specificities specific to each pathology

Other signs distinguish these two "false brothers". Is your skin supple but hurts when pinched, your symptoms progress to bruising and signs of venous insufficiency? No doubt, this is the signature of a lipoedema, none of these signs occurring in lymphedema. On the other hand, in the latter, when you pinch the dorsal side of the second toe, the skin at this level is impasto and impossible to wrinkle... This is the famous "Stemmer's sign" which does not exist in lipedema.

And if necessary, there is even an examination that removes any doubt: "lymphoscintigraphy" capable of revealing an alteration in the lymphatic pathways. If so, we are then faced with lymphedema, otherwise it is a lipoedema. Finally, the people affected also differ. While almost all people with lipedema are women – up to 17% of the female population, 85% of whom are obese according to some studies – lymphedema can affect both sexes, even if it mainly affects young women.

… requiring very distinct care

For lymphedema, the strategy consists above all of decongesting the legs by various techniques: multilayer bandages with little elasticity, manual lymphatic drainage, exercises under bandages to increase lymphatic flow... and finally wearing elastic compression. Called "decongestive physiotherapy", this strategy is carried out in two stages: a first intensive phase intended to reduce the volume of the legs, then a maintenance phase to stabilize the result obtained in the long term.

But it is not suitable for lipoedema, the management of which is often more complex: bandages that are not very effective, elastic compressions that are often too difficult to put on and bear, etc. Fortunately, other effective treatments can be offered: balneotherapy, pneumatic pressotherapy, etc. or even surgery with skin resection and liposuction. The aim is to reduce abnormal fat deposits in compressed areas. This will then allow the easier use of elastic compressions.

If you have any other questions, ask your doctor for advice.