Differential diagnosis protocol for lipoedema:
From a member post by “Itobo” of UK Lymph Forums
Proceed to Section B only if the answer is Yes to at least one of the following:
1. Pattern of fat concentrated in abdomen and thighs (pear shape)?
2. Ankles and feet, AND/OR wrists and hands are smaller than would be expected for the weight on the remainder of the body?
3. Reports consistent difficulty in losing weight after just one to four weeks of initial success?
Proceed to Section C if:
A. The answer to two or more of the first six questions is Yes; and/or
B. The answer to one or both of questions 7 or 8 is Yes; and/or
C. The patient is under 30, and the answer is yes to two or more of questions 9-12, and at least one of questions 1-8.
1. Based on your clinical experience, is this person’s weight higher than you would have expected?
2. Is there adipose tissue evident in the affected areas, particularly the abdomen and/or the thighs? (cottage cheese skin extending below the buttocks)
3. Is there evidence of a weakened immune system (frequent colds, bronchial infections, onset of asthma, etc.) which is not otherwise explained?
4. Are there joint pains which cannot be otherwise explained (eg. Symptoms similar to gout, without high uric acid levels; pain in the knee, without evidence of arthritis or rheumatic condition).
5. Is the pattern of weight in each leg symmetrical?
6. Does the patient report pain emanating from the adipose tissue, particularly when pressure is applied?
7. Is there edema (pitting or non-pitting) evident on the ankle?
8. Is there a history of cellulitis, sensitivity to sun, and/or adverse reactions to insect bites?
9. Is there a family history of thyroid or hormonal disorders?
10. Is there evidence of flat feet?
11. Is there evidence of papilloma (skin tags) or peau d’orange skin (rough, resembling an orange peel), particularly between the thighs?
12. Is there a family history of obesity that is concentrated among female relatives (cousins, siblings, parents, children, aunts), or is there a diagnosis of lipoedema or lipo-lymphoedema among any close relatives?
In the above, questions 1-6 relate to both lipoedema and lipo-lymphoedema. Questions 7 and 8 relate more closely to lipo-lymphoedema. Questions 9-12 relate to indicators commonly reported by those with one of these conditions.
Continue to this section only if indicated by Section B.
Lipoedema or lipo-lymphoedema (if pitting edema or significant ankle/foot edema is present) should be suspected. Follow up with a one week treatment regimen involving 1.5 hour daily manual lymphatic drainage (MLD), accompanied by day and night-time compression bandaging using short stretch bandages. Treat the leg with the largest measurements. Compare measurements of the treated leg to its pre-treatment size, as well as to the untreated leg.
If treatment results in a reduction in limb volume in the treated limb, follow up with complex decongestive therapy regimen (MLD, short stretch bandaging, skin treatment, and compression garments following the completion of treatment). For lipoedema, the normal treatment period is 2-4 weeks with 1 – 1.5 hours of treatment daily, six days per week. For lipo-lymphoedema, the normal treatment period is 3-4 weeks with 1.5 – 3 hours of treatment daily, 6-7 days per week.
NOTE: Lipoedema and lipo-lymphedema can also occur in the arms and chest. Normally, abdominal and thigh deposits will also be evident when this occurs. However, this is not always the case.