"If we can make the correct diagnosis, then the healing can begin."
Dr Andrew Weil



Usually swollen legs and ankles with normal feet



Lipomas are painful, especially when pressed or palpated


Lipedema is a relatively common fat disorder that affect up to 11% of women. For reasons not yet known, fat is abnormally distributed usually in the buttocks, hips, legs and occasionally the arms. Although it begins as a cosmetic concern, it can eventually cause pain and other problems. In fact, lipedema is sometimes called The Painful Fat Syndrome. Lipedema can be mistaken for regular obesity or lymphedema, however, there are many distinguishing features of Lipedema. In Lipedema, usually the midriff area is spared, so there is a disproportionate enlargement of the lower body as compared to the upper body. Also the lower legs tend to take on a columnar shape w swelling to the ankle, but the foot is usually spared. There are other classic findings, as well.

One hallmark of Lipedema is the fat is relatively unresponsive to diet and exercise. The skin tends to bruise easily and the consistency of the skin can become soft and spongy. Currently, the cause for lipedema is unknown and there are no definitive treatments, other than a specialized type of lymphatic sparing liposuction, but insurance companies consider liposuction a cosmetic procedure, so it is not covered by insurance.

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Dercum's Disease

Dercum’s Disease (DD) is also called Adiposis Dolorosa. DD is a rare disorder, which is more common in women than men, and is characterized by multiple, painful growths of fatty tissue called lipomas. Usually, these lipomas are painful, especially when pressed or palpated. DD can be described as either Diffuse, Nodular or Mixed depending on the size and location of the lipomas.

            Diffuse DD – small lipomas are found throughout the subcutaneous tissue usually
                        beginning around the elbow and inner knee areas. 

            Nodular DD – the lipomas are larger and can be the size of marbles, golf balls or fist.
                        These lipomas are usually found on the arms, rib cage, abdomen, low back,
                        buttocks and thighs.

            Mixed DD – frequently there is a mixed pattern that includes features of both diffuse and
                        nodular lipomatous findings.

There is no blood test or x ray to diagnosis of DD. The diagnosis of DD is made clinically based on history and physical exam. Also, DD is considered a diagnosis of exclusion which means the diagnosis can be made after other conditions like lipedema, fibromyalgia and familial multiple lipomatosis are ruled out.  

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