Introduction

This section covers basic information on lipedema and includes these pages:

For more detail on lipedema, see Subcutaneous Adipose Tissue Diseases: Dercum Disease, Lipedema, Familial Multiple Lipomatosis, and Madelung Disease

Lymphedema is included because the signs and symptoms of lipedema are frequently mistaken for lymphedema, a person may have both conditions, and because lipedema can cause lymphedema.

Signs and symptoms of lymphedema and lipedema include increasing swelling (edema), fat accumulation, skin changes, and increased risk of infection (cellulitis, wounds, or ulcers) in affected areas, as explained below.

Lymphedema and lipedema are chronic progressive conditions that can become painful, depressing, disfiguring, disabling, and (potentially) deadly, without treatment. Treatment and self-care (including nutrition) relieves pain and other symptoms and can slow the progression of these conditions. See Treatment for more information on treatment and other health care considerations.

Early recognition, diagnosis, and treatment provide the best results. Follow-up with your health care provider if you think you have lymphedema or lipedema but have not been diagnosed.

Signs and Symptoms

Remain alert to potential signs and symptoms and follow up with your health care provider, especially if a tissue infection is your first sign of lymphedema.

Signs and symptoms of lymphedema and lipedema include:

Skin or tissue infection (cellulitis) or a history of infection, can be a sign, or the first sign, of lymphedema because these infections are rare in normal skin. If you are at risk for lymphedema, seek medical care immediately if you have signs of a skin infection: localized redness, warmth, raised areas, body ache, malaise, increased joint pain, fever, chills, etc.
Persistent swelling (edema) that does not go away with rest or elevation and lacks a known cause, such as a sprain or other injury. Swelling may start near the trunk of the body (proximal) or at the distant end of a limb (distal) depending on the causes.
Skin color is generally normal for swelling from lymphedema or lipedema; if the swollen area is red, angry, itchy, or hot, that may indicate an infection. Multi-color bruising indicates an injury; dark stains on swollen areas indicate blood leakage from venous disease and phlebolymphedema.
Legs or thighs that are symmetrically larger or heavy (at least initially), and out of proportion with the upper body, are characteristics of lipedema. Leg swelling from lymphedema is not usually symmetric.
Cankles or unusually thick ankles can be signs of either lymphedema or lipedema. Lymphedema starts with swelling that becomes fat, includes the toes, and is rarely symmetric; lipedema fat on the legs is symmetric and stops at the ankles initially (see Photos of Lymphedema and Lipedema) and does not involve the feet until advanced stages (Stage 4).
Arm fat accumulation that is symmetrical on both arms (biceps or triceps) can also be lipedema. See Photos of Lymphedema and Lipedema for examples.
Abdominal fat and swelling (belly fat) can expand to form a hanging flap or apron (abdominal panniculus).
Swelling or fat in the trunk or genitals.
Painful fat that is tender to touch and bruises easily is characteristic of lipedema.
Feeling of aching or heaviness in the at-risk limb, even before there is noticeable swelling.
Rings, bracelets, sleeves, socks, or shoes that suddenly feel too tight or do not fit.
Lipedema fat may initially (very early stage) look and feel exceptionally soft and smooth, like butter. As lipedema progresses, fat cells become progressively larger and the skin no longer feels smooth; in later stages visible nodules (cellulite) cause the skin to look and feel dimpled or lumpy and fatty protrusions may develop.
Wounds or ulcers that are unusually slow to heal or not healing.

Skin changes in areas affected by lymphedema may include:

Swollen skin that initially feels soft or watery and will indent if pressed (pitting edema). Stretch marks may appear on the stretched skin.
Saggy loose skin, following a reduction in swelling. For example, during intensive lymphedema treatment.
Stiffer, gel-like, and lumpy skin due to protein build-up during the early stages of fibrosis.
Hard, leathery, or scaly skin from continued protein build-up and advanced fibrosis.
Red and inflamed skin that has stretched to accommodate extra fluid.
Blisters from fluid buildup and watery fluid escaping from openings in the skin (weeping lymphedema, or lymphorrhea).
Orange peel appearance (peau d’orange) of thickened skin with congested lymph vessels.
Warty growths (papillomas), especially on the legs.

See Lymphedema vs. Lipedema for the factors that distinguish lymphedema from lipedema and Photos of Lymphedema and Lipedema.

Portions adapted from Lymphedema and Lipedema Nutrition Guide, Lymph Notes 2016 by permission of the publisher.