Lipedema: exploring pathophysiology and treatment strategies – state of the art
Lipedema: explorando a fisiopatologia e estratégias de tratamento – estado da arte
Fabio Kamamoto; Jaqueline Munaretto Timm Baiocchi; Bernardo Nogueira Batista; Renan Diego Américo Ribeiro; Débora Aparecida Oliveira Modena; Vitor Cervantes Gornati
Abstract
Keywords
Resumo
O lipedema é caracterizado pela deposição anormal de gordura em áreas como braços, quadris, nádegas e coxas, poupando as mãos e os pés. Os sintomas incluem dor, hematomas, edema e nódulos subcutâneos, que resistem a intervenções tradicionais, como dieta e exercício. Apesar do crescente reconhecimento, a compreensão abrangente, incluindo aspectos fisiopatológicos, clínicos e terapêuticos, ainda não está totalmente consolidada. Esta revisão tem como objetivo preencher lacunas no conhecimento da área, visando um manejo mais informado do lipedema. Foi possível proporcionar uma compreensão mais aprofundada do tratamento do lipedema, abordando a fisiopatologia e as opções terapêuticas. Os dados revelaram avanços no conhecimento, principalmente no que diz respeito aos tratamentos conservadores e cirúrgicos, com foco na melhoria da qualidade de vida. No entanto, continuam faltando evidências científicas que apoiem a segurança e a eficácia de vários tratamentos. A necessidade de pesquisas adicionais é enfatizada para garantir a segurança e aumentar a eficácia do manejo dessa condição complexa.
Palavras-chave
Referências
1 Lyon IP. Adipose and Lipomatosis: considered in reference to their constitutional relationships and symptoms. Arch Intern Med (Chic). 1910;VI(1):28-120.
2 Allen EV, Hines EA Jr. Lipedema of the legs: a syndrome characterized by fat legs and orthostatic edema. Proc Staff Meet Mayo Clin. 1940;15:184-7.
3 Wold LE, Hines EA Jr, Allen EV. Lipedema of the legs; a syndrome characterized by fat legs and edema. Ann Intern Med. 1951;34(5):1243-50.
4 Vyas A, Adnan G. Lipedema. Treasure Island (FL): StatPearls; 2023.
5 Fife CE, Maus EA, Carter MJ. Lipedema: afrequently misdiagnosed and misunderstood fatty deposition syndrome. Adv Skin Wound Care. 2010;23(2):81-92, quiz 93-4.
6 Bauer AT, von Lukowicz D, Lossagk K, et al. New insights on lipedema: the enigmatic disease of the peripheral fat. Plast Reconstr Surg. 2019;144(6):1475-84.
7 Dudek JE, Białaszek W, Gabriel M. Quality of life, its factors, and sociodemographic characteristics of Polish women with lipedema. BMC Womens Health. 2021;21(1):27.
8 Amato ACM, Amato FCM, Amato JLS, Benitti DA. Lipedema prevalence and risk factors in Brazil. J Vasc Bras. 2022;21:e20210198.
9 Child AH, Gordon KD, Sharpe P, et al. Lipedema: an inherited condition. Am J Med Genet A. 2010;152A(4):970-6.
10 Amato ACM, Amato FCM, Amato JLS, Benitti DA. Prevalência e fatores de risco do lipedema no Brasil. J Vasc Bras. 2022;21:e20210198. PMid:35677743.
11 Bertlich M, Jakob M, Bertlich I, Schift R, Bertlich R. Lipedema in a male patient: report of a rare case - management and review of the literature. GMS Interdiscip Plast Reconstr Surg DGPW. 2021;10:11. PMid:34660173.
12 Paolacci S, Precone V, Acquaviva F, et al. Genetics of lipedema: new perspectives on genetic research and moleculares diagnoses. Eur Rev Med Pharmacol Sci. 2019;23(13):5581-94. PMid:31298310.
13 Bauer AT, von Lukowicz D, Lossagk K, et al. New insights into lipedema: the enigmatic disease of peripheral fat. Plast Reconstr Surg. 2019;144(6):1475-84.
14 Van La Parra RFD, Deconinck C, Pirson G, Servaes M, Fosseprez P. Lipedema: what we don’t know. J Plast Reconstr Aesthet Surg. 2023;84:302-12.
15 Katzer K, Hill JL, McIver KB, Foster MT. Lipedema and the potential role of estrogen in excessive adipose tissue accumulation. Int J Mol Sci. 2021;22(21):11720.
16 Bardhi O, Palmer BF, Clegg DJ. The evolutionary impact and influence of oestrogens on adipose tissue structure and function. Philos Trans R Soc Lond B Biol Sci. 2023;378(1885):20220207.
17 Szél E, Kemény L, Groma G, Szolnoky G. Pathophysiological dilemmas of lipedema. Med Hypotheses. 2014;83(5):599-606.
18 Felmerer G, Stylianaki A, Hägerling R, et al. Adipose Tissue Hypertrophy, An Aberrant Biochemical Profile and Distinct Gene Expression in Lipedema. J Surg Res. 2020;253:294-303.
19 Suga H, Araki J, Aoi N, Kato H, Higashino T, Yoshimura K. Adipose tissue remodeling in lipedema: adipocyte death and concurrent regeneration. J Cutan Pathol. 2009;36(12):1293-8.
20 Kruppa P, Georgiou I, Biermann N, Prantl L, Klein-Weigel P, Ghods M. Lipedema-Pathogenesis, Diagnosis, and Treatment Options. Dtsch Arztebl Int. 2020;117(22-23):396-403. PMid:32762835.
21 Bauer AT, von Lukowicz D, Lossagk K, et al. Adipose Stem Cells from Lipedema and Control Adipose Tissue Respond Differently to Adipogenic Stimulation In Vitro. Plast Reconstr Surg. 2019;144(3):623-32.
22 Vasella M, Wolf S, Francis EC, et al. Involvement of the Macrophage Migration Inhibitory Factor (MIF) in Lipedema. Metabolites. 2023;13(10):1105.
23 Al-Ghadban S, Cromer W, Allen M, et al. Dilated Blood and Lymphatic Microvessels, Angiogenesis, Increased Macrophages, and Adipocyte Hypertrophy in Lipedema Thigh Skin and Fat Tissue. J Obes. 2019;2019:8747461.
24 Chachaj A, Dudka I, Jeziorek M, Sowicz M, Adaszyńska A, Szuba A. Lymphoscintigraphic alterations in lower limbs in women with lipedema in comparison to women with overweight/obesity. Front Physiol. 2023;14:1099555.
25 Duhon BH, Phan TT, Taylor SL, Crescenzi RL, Rutkowski JM. Current mechanistic understandings of lymphedema and lipedema: tales of fluid, fat, and fibrosis. Int J Mol Sci. 2022;23(12):6621.
26 Buso G, Depairon M, Tomson D, Raffoul W, Vettor R, Mazzolai L. Lipedema: a call to action! Obesity (Silver Spring). 2019;27(10):1567-76.
27 Langendoen SI, Habbema L, Nijsten TE, Neumann HA. Lipoedema: from clinical presentation to therapy. A review of the literature. Br J Dermatol. 2009;161(5):980-6.
28 Dean SM, Valenti E, Hock K, Leffler J, Compston A, Abraham WT. The clinical characteristics of lower extremity lymphedema in 440 patients. J Vasc Surg Venous Lymphat Disord. 2020;8(5):851-9.
29 Forner-Cordero I, Szolnoky G, Forner-Cordero A, Kemény L. Lipedema: an overview of its clinical manifestations, diagnosis and treatment of the disproportional fatty deposition syndrome - systematic review. Clin Obes. 2012;2(3-4):86-95.
30 Amato ACM, Amato FCM, Benitti DA, Amato LGL. Development of a questionnaire and screening model for lipedema. J Vasc Bras. 2020 Dec 11;19:e20200114. PMID: 34211528.
30 Amato ACM, Amato FCM, Benitti DA, Santos RV. Tradução, adaptação cultural e validação do questionário de avaliação sintomática do lipedema (QuASiL). J Vasc Bras. 2020;19:e20200049.
31 Naouri M, Samimi M, Atlan M, et al. High-resolution cutaneous ultrasonography to differentiate lipoedema from lymphoedema. Br J Dermatol. 2010;163(2):296-301.
32 Iker E, Mayfield CK, Gould DJ, Patel KM. Characterizing lower extremity lymphedema and lipedema with cutaneous ultrasonography and an objective computer-assisted measurement of dermal echogenicity. Lymphat Res Biol. 2019;17(5):525-30.
33 Güvener O, Ricci V, Özçakar L. Ultrasound examination for en-suite measurements in lipedema. Phlebology. 2022;37(4):312-3.
34 Cestari M. Lipedema: usefulness of 3D ultrasound diagnostics. Lymphat Res Biol. 2023;21(5):485-7.
35 Rockson SG. Three-dimensional ultrasonography for lipedema diagnosis. Lymphat Res Biol. 2023;21(5):431.
36 Amato ACM, Saucedo DZ, Santos KDS, Benitti DA. Ultrasound criteria for lipedema diagnosis. Phlebology. 2021;36(8):651-8.
37 Di Renzo L, Gualtieri P, Alwardat N, et al. The role of IL-6 gene polymorphisms in the risk of lipedema. Eur Rev Med Pharmacol Sci. 2020;24(6):3236-44. PMid:32271442.
38 Precone V, Barati S, Paolacci S, et al. Genetic syndromes with localized subcutaneous fat tissue accumulation. Acta Biomed. 2019;90(10-S):90-2. PMid:31577262.
39 Klimentidis YC, Chen Z, Gonzalez-Garay ML, et al. Genome-wide association study of a lipedema phenotype among women in the UK Biobank identifies multiple genetic risk factors. Eur J Hum Genet. 2023;31(3):338-44.
40 Van Esch-Smeenge J, Damstra RJ, Hendrickx AA. Força muscular e capacidade funcional de exercício em pacientes com lipoedema e obesidade: um estudo comparativo. J Linfedema. 2017;12:27-31.
41 Herbst KL, Kahn LA, Iker E, et al. Standard of care for lipedema in the United States. Phlebology. 2021;36(10):779-96.
42 Keith L, Seo CA, Rowsemitt C, et al. Ketogenic diet as a potential intervention for lipedema. Med Hypotheses. 2021;146:110435.
43 Di Renzo L, Cinelli G, Romano L, et al. Potential Effects of a Modified Mediterranean Diet on Body Composition in Lipoedema. Nutrients. 2021;13(2):358.
44 Bonetti G, Herbst KL, Dhuli K, et al. Dietary supplements for lipedema. J Prev Med Hyg. 2022;63(2 Suppl 3):E169-73. PMid:36479502.
45 Fetzer A. Specialist approaches to managing lipoedema. Br J Community Nurs. 2016;21(Suppl 4):S30-5.
46 Esmer M, Schingale FJ, Unal D, Yazıcı MV, Güzel NA. Physiotherapy and rehabilitation applications in lipedema management: a literature review. Lymphology. 2020;53(2):88-95.
47 Lasinski BB. Complete decongestive therapy for treatment of lymphedema. Semin Oncol Nurs. 2013;29(1):20-7.
48 Atan T, Bahar-Özdemir Y. The effects of complete decongestive therapy or intermittent pneumatic compression therapy or exercise only in the treatment of severe lipedema: a randomized controlled trial. Lymphat Res Biol. 2021;19(1):86-95.
49 Donahue PMC, Crescenzi R, Petersen KJ, et al. Physical therapy in women with early stage lipedema: potential impact of multimodal manual therapy, compression, exercise, and education interventions. Lymphat Res Biol. 2022;20(4):382-90.
50 Szolnoky G, Borsos B, Bársony K, Balogh M, Kemény L. Complete decongestive physiotherapy with and without pneumatic compression for treatment of lipedema: a pilot study. Lymphology. 2008;41(1):40-4. PMid:18581957.
51 Czerwińska M, Teodorczyk J, Spychała D, Hansdorfer-Korzon R. The Usefulness of the Application of Compression Therapy among Lipedema Patients-Pilot Study. Int J Environ Res Public Health. 2023;20(2):914.
52 Podda M, Kovacs M, Hellmich M, et al. A randomised controlled multicentre investigator-blinded clinical trial comparing efficacy and safety of surgery versus complex physical decongestive therapy for lipedema (LIPLEG). Trials. 2021;22(1):758.
53 Bertsch T. Compression garments for pain management, comfort and freedom of movement in lipoedema patients: clinical benefits of JOBST® Confidence. Br J Community Nurs. 2022;27(Sup9):S22.
54 Czerwińska M, Teodorczyk J, Spychała D, Hansdorfer-Korzon R. The usefulness of the application of compression therapy among lipedema patients-pilot study. Int J Environ Res Public Health. 2023;20(2):914.
55 Cooper-Stanton G. Flat knit hosiery: purpose, selection and application in chronic edema and lipoedema. Br J Community Nurs. 2019;24(Sup4):S12-6.
56 Paling I, Macintyre L. Survey of lipoedema symptoms and experience with compression garments. Br J Community Nurs. 2020;25(Sup4):S17-22.
57 Schwahn-Schreiber C, Breu FX, Rabe E, et al. Diretriz S1 compressão pneumática intermitente (IPK, AIK). Dermatologista. 2018;69:662-73.
58 Rasmussen JC, Aldrich MB, Fife CE, Herbst KL, Sevick-Muraca EM. Lymphatic function and anatomy in early stages of lipedema. Obesity (Silver Spring). 2022;30(7):1391-400.
59 Wright T, Scarfino CD, O’Malley EM. Effect of pneumatic compression device and stocking use on symptoms and quality of life in women with lipedema: A proof-in-principle randomized trial. Phlebology. 2023;38(1):51-61.
60 Schneider R. Low-frequency vibrotherapy considerably improves the effectiveness of manual lymphatic drainage (MLD) in patients with lipedema: a two-armed, randomized, controlled pragmatic trial. Physiother Theory Pract. 2020;36(1):63-70.
61 Herbst KL, Ussery C, Eekema A. Pilot study: whole body manual subcutaneous adipose tissue (SAT) therapy improved pain and SAT structure in women with lipedema. Horm Mol Biol Clin Investig. 2017;33(2):20170035.
62 Ibarra M, Eekema A, Ussery C, Neuhardt D, Garby K, Herbst KL. Subcutaneous adipose tissue therapy reduces fat by dual X-ray absorptiometry scan and improves tissue structure by ultrasound in women with lipoedema and Dercum disease. Clin Obes. 2018;8(6):398-406.
63 Modena DAO, Soares CD, Candido EC, Chaim FDM, Cazzo E, Chaim EA. Effect of extracorporeal shock waves on inflammation and angiogenesis of integumentary tissue in obese individuals: stimulating repair and regeneration. Lasers Med Sci. 2022;37(2):1289-97.
64 Modena DAO, Guidi RM, Soares CD, Cazzo E, Chaim EA. Electromagnetic shock waves in Dermatology: microscopic analysis of their interaction with the possible reduction of adipose tissue. Surg Cosmet Dermatol. 2020;04:352-8.
65 Tsai YL, I TJ, Chuang YC, Cheng YY, Lee YC. Extracorporeal shock wave therapy combined with complex decongestive therapy in patients with breast cancer-related lymphedema: a systemic review and meta-analysis. J Clin Med. 2021;10(24):5970.
66 Siems W, Grune T, Voss P, Brenke R. Anti-fibrosclerotic effects of shock wave therapy in lipedema and cellulite. Biofactors. 2005;24(1-4):275-82.
67 Michelini S, Musa F, Vetrano M, et al. Defocused and radial shock wave therapy, mesotherapy, and kinesio taping effects in patients with lipedema: a pilot study. Lymphology. 2023;56(1):13-26.
68 Baxter GD, Liu L, Petrich S, et al. Low level laser therapy (Photobiomodulation therapy) for breast cancer-related lymphedema: a systematic review. BMC Cancer. 2017;17(1):833.
69 Chen HY, Tsai HH, Tam KW, Huang TW. Effects of photobiomodualtion therapy on breast cancer-related lymphoedema: a systematic review and meta-analysis of randomised controlled trials. Complement Ther Med. 2019;47:102200.
70 Chiu ST, Lai UH, Huang YC, Leong CP, Chen PC. Effect of various photobiomodulation regimens on breast cancer-related lymphedema: A systematic review and meta-analysis. Lasers Med Sci. 2023;39(1):11.
71 Smoot B, Chiavola-Larson L, Lee J, Manibusan H, Allen DD. Effect of low-level laser therapy on pain and swelling in women with breast cancer-related lymphedema: a systematic review and meta-analysis. J Cancer Surviv. 2015;9(2):287-304.
72 Modena DAO, Soares CD, Martignago CCS, Almeida S, Cazzo E, Chaim EA. Effects of LED photobiomodulation therapy on the subcutaneous fatty tissue of obese individuals - histological and immunohistochemical analysis. J Cosmet Laser Ther. 2022;24(6-8):84-90.
73 Modena DAO, Ferro AP, de Oliveira Guirro EC, Cazzo E, Chaim EA. Photobiomodulation therapy with light-emitting diode in stimulating adipose tissue mitochondria. Lasers Med Sci. 2023;38(1):238.
74 Peprah K, MacDougall D. Liposuction for the treatment of lipedema: a review of clinical effectiveness and guidelines. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2019.
75 Seefeldt T, Aitzetmüller-Klietz ML, Kückelhaus M, et al. Breaking the circle-effectiveness of liposuction in lipedema. J Dtsch Dermatol Ges. 2023;21(6):601-9.
76 Baumgartner A, Hueppe M, Meier-Vollrath I, Schmeller W. Improvements in patients with lipedema 4, 8 and 12 years after liposuction. Phlebology. 2021;36(2):152-9.
77 Georgiou I, Kruppa P, Schmidt J, Ghods M. Liposuction for Lipedema: Functional Therapy or Aesthetic Procedure? Aesthetic Plast Surg. 2021;45(1):212-3.
78 Brasil. Resolução CFM nº 1.711 de 10/12/2003. Estabelece parâmetros de segurança que devem ser observados nas cirurgias de lipoaspiração, visando garantir ao paciente o direito de decisão pós-informada e aos médicos, os limites e critérios de execução. Diário Oficial da União; Brasília; 2004 [cited 2024 Jan 3].
79 Alwardat N, Di Renzo L, Alwardat M, et al. The effect of lipedema on health-related quality of life and psychological status: a narrative review of the literature. Eat Weight Disord. 2020;25(4):851-6.
80 Dudek JE, Białaszek W, Ostaszewski P, Smidt T. Depression and appearance-related distress in functioning with lipedema. Psychol Health Med. 2018;23(7):846-53.
Submetido em:
27/06/2024
Aceito em:
11/10/2024