Lipedema diagnosis: How is lipedema diagnosed?

For many affected individuals, the diagnosis of lipedema is the first step on the road to recovery—and at the same time, it raises many questions and uncertainties. It is important to us to support our patients professionally, empathetically, and comprehensively from the very beginning.

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Medical history: The first step toward diagnosing lipedema

The diagnosis begins with a detailed medical history. Often, lipedema can be suspected based on a patient’s medical history, especially if similar conditions have already occurred in the family. We take plenty of time to get to know you and your medical history in order to gain a thorough understanding of your condition. On this basis, we can focus on where you need help.

Lipedema examination: visual assessment and pinch test

The medical history is followed by a physical examination. The affected areas are inspected and palpated. A typical indication is the symmetrical occurrence of fat accumulation on the arms or legs.
The pinch test is a simple but effective means of initial assessment: if there is a significantly increased sensitivity to pain on the outside of the thighs compared to the inside, this may indicate lipedema.

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Palpation and tissue texture

Palpation often reveals hardened or nodular structures in the subcutaneous fatty tissue that are characteristic of lipedema. Increased sensitivity to pressure and a tendency to bruise also support the clinical assessment.

Lipedema or another condition? Recognizing the differences.

Lipedema must be clearly distinguished from other similar conditions:

Lymphedema: Lymphedema is a condition in which a disorder of the lymphatic system leads to an accumulation of lymph fluid, usually in the arms or legs. This causes swelling that can change throughout the day and typically occurs on one side of the body. Unlike lipedema, lymphedema does not occur symmetrically. In addition, lymphedema is not painful like lipedema. It can occur, for example, after cancer treatment when lymph nodes have been removed.
Obesity is characterized by excessive fat accumulation in the body and can be caused by a high-calorie diet and lack of exercise. We also refer to this as adiposity. In obesity, the fat is evenly distributed without the pain typical of lipedema and without being concentrated in specific areas such as the legs or arms. In addition, unlike lipedema, obesity can be positively influenced by exercise and a healthy, low-calorie diet.
Lipohypertrophy: This condition refers to an accumulation of subcutaneous fatty tissue that is not caused by general weight gain. It can also be hereditary. Lipohypertrophy does not normally cause pain, which clearly distinguishes it from lipedema.
Other conditions with similar symptoms include polycystic ovary syndrome (a hormonal disorder in women), endometriosis (tissue similar to the lining of the uterus grows in the abdominal cavity), thyroid disorders (Hashimoto’s disease, goiter, Graves’ disease, etc.), eating disorders, depression, venous disorders, or Decrum’s disease (fat deposits in connective tissue).

An examination by an experienced specialist is essential for a definitive diagnosis of lipedema. Nevertheless, measuring the waist-to-hip ratio provides those affected with useful initial guidance, as it takes fat distribution into account and can therefore provide meaningful indications of a pathological fat distribution disorder.

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Lipedema diagnosis with ultrasound as a complementary diagnostic tool

Ultrasound examination cannot clearly distinguish lipedema from healthy fatty tissue, but it does provide valuable additional information. That is why we at LIPOCURA® use sonography specifically to supplement clinical examination in order to objectively assess the density and structure of fatty tissue. In patients with lipedema, ultrasound often reveals a wavy, nodular structure comparable to so-called “fat tissue granules.” These findings help us plan the subsequent therapy.

Another important component is the standardized measurement of tissue thickness in the subcutaneous fat tissue (subcutis) and the overlying skin layer (cutis). This sonographic assessment makes it possible to objectively determine the extent of fat tissue proliferation and better classify the severity of lipedema.

At LIPOCURA®, we use the classification system developed by Marshall and Sehwahn-Schreiber, which distinguishes between the following stages:

12–15 mm: mild lipedema or lipohyperplasia
15–20 mm: moderate lipedema
20–30 mm: pronounced lipedema
over 30 mm: severe lipedema

These measurements are not only diagnostically relevant for us, but also serve as the basis for individualized and precise treatment planning.

Exclusion of lymphedema: Stemmer sign

Stemmer sign is used to detect lymphedema. It involves attempting to lift a skin fold above the second and third toes. If this fold is thickened, difficult to lift, or cannot be lifted due to tissue hardening, Stemmers’ sign is positive and indicates lymphedema.

A negative result does not rule out lymphedema, but it can reduce suspicion—especially in combination with other findings.

In practice, the test is used as part of an overall picture—not as the sole basis for a decision.

Obtain a second opinion on the lipedema diagnosis

If preliminary findings are already available or there are uncertainties, it may be advisable to seek a second opinion from an experienced specialist. It is important to us that our patients can rely on an accurate diagnosis as the basis for the best possible treatment.

FAQ

Frequently asked questions about lipedema diagnosis

How is lipedema diagnosed?

The diagnosis is made through a clinical examination that looks for typical symptoms such as symmetrical fat accumulation, pressure pain, and a tendency to develop hematomas. In addition, a pinch test and, if necessary, imaging procedures can be used to rule out other diseases.

Can lipedema and lymphedema occur together?

It is possible for lipedema and lymphedema to occur simultaneously, which is then referred to as lipo-lymphedema. Lipedema that remains untreated for a long period of time can lead to lymphedema, which is why early detection and treatment tailored to the individual affected are extremely important. In addition, lipedema is often misdiagnosed as lymphedema due to its relative obscurity.

How do the symptoms of lipedema and lymphedema differ?

Lipedema and lymphedema are both tissue disorders that can cause swelling. Despite their similar names and the frequent risk of confusion, they differ in their causes and signs.

	Lipedema	Lymphoedema
Emergence	Formation of abnormal fatty tissue that is irregularly distributed.	Disorder in the lymphatic system - fluid build-up in the tissues
Symptoms	Occurs symmetrically, pain, tenderness, heaviness in the legs, tendency to bruise, ...	Swelling is often stronger in one part of the body, skin is tense and hard, skin changes possible in advanced stages
Time of occurrence	Begins at puberty, pregnancy or menopause. Worsening over time possible.	After previous illness, infection or surgery, especially if lymph nodes have been removed.
Side effects	Restrictions in mobility/axial malposition and joint damage as well as inflammation of the skin flaps possible.	Repeated skin infections and thickening.