ASSESSMENT & DIAGNOSIS
The diagnosis of lipedema is based on clinical evidence and exclusion criteria. In 2017 based on clinical experience and literature evidence a modified version of diagnostic criteria was published by Halk and Damstra.
In Table. 1 a slightly modified version of the diagnostic criteria of lipedema has been published and it can help with further distinguishing the features and managing the disease in time.
Table 1. Diagnostic criteria of lipedema:
Medical history (A)
A:
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Disproportionate body fat distribution
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No or limited influence of weight loss on fat distribution
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Limb pain and bruising
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Increased sensitivity to touch or limb fatigue
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Non Pitting edema
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No reduction of pain or discomfort with limb lift
Physical examination (B, C, D, E)
B. Proximal part of the lower limb
1. Disproportionate fat distribution
2. Circumferentially thickened cutaneous fat
C.Distal Part of lower limb
1. Proximal thickening of subcutaneous fat
2. Distal thickening of subcutaneous fat, accompanied by slender instep (cuff sign)
D. Proximal part of the arm
1. Significantly thickened subcutaneous fat in comparison with vicinity
2. Sudden stop at elbow
E. Distal part of the arm
1. Thickened subcutaneous fat, accompanied by slender back of hand (cuff sign)
F. Extra criteria
1. Pain when applying bimanual palpation
2. Distal fat tissue tendrils of the knee (popliteus)
The following criteria can be followed.
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Diagnosis is highly probable when present: A (1 to 6) + (B [1 + 2] or C [1 + 2] or D [1 + 2] or E).
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In the absence of at most two of these criteria (A to E), the presence of the extra criteria F(1) or F(2) also support the diagnosis.