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Understanding of lipedema and its diagnostic criteria has evolved over the years thanks to international studies and the involvement of multidisciplinary working groups. This document summarizes the consensus reached in various countries as well as the most recent recommendations for an accurate diagnosis of this still underdiagnosed condition.
The Dutch consensus laid the groundwork for understanding lipedema by highlighting the disproportionate distribution of subcutaneous fat between the upper and lower body, sparing the hands and feet. Allodynia (increased sensitivity to touch) and significant thickening of subcutaneous fat, often marked by an abrupt termination at the joints, are key criteria supporting the diagnosis.
This consensus expanded the diagnostic criteria by emphasizing pain during the “pinch test” as a key factor. According to their research, lipedema does not show free fluid on ultrasound, unlike other conditions such as obesity or lymphedema.
The U.S. criteria include factors such as:
The German guidelines take a rigorous clinical approach, emphasizing the following points:
The latest updates (Herbst, 2024) have brought about a paradigm shift. Rather than focusing on a hypothetical edema, the current approach aims to treat the primary symptoms:
To make an accurate diagnosis, it is essential to distinguish lipedema from the following conditions:
Although ultrasound can provide valuable information about subcutaneous tissues, it should not be considered the sole diagnostic tool. Current studies show that the tissue structure of lipedema differs significantly from that of other conditions, but standardized criteria are still lacking.
The diagnosis of lipedema relies on a thorough clinical evaluation and the careful exclusion of other conditions. Recent advances highlight the importance of a comprehensive approach that addresses both physical and psychological aspects. Improvements in diagnostic tools and international collaboration will continue to play a key role in the recognition and treatment of this complex condition.
This article was written by Drs. Michelle Cazaubon and Nicolas Zwillinger.
Understanding of lipedema and its diagnostic criteria has evolved over the years thanks to international studies and the involvement of multidisciplinary working groups. This document summarizes the consensus reached in various countries as well as the most recent recommendations for an accurate diagnosis of this still underdiagnosed condition.
Understanding of lipedema and its diagnostic criteria has evolved over the years thanks to international studies and the involvement of multidisciplinary working groups. This document summarizes the consensus reached in various countries as well as the most recent recommendations for an accurate diagnosis of this still underdiagnosed condition.
Understanding of lipedema and its diagnostic criteria has evolved over the years thanks to international studies and the involvement of multidisciplinary working groups. This document summarizes the consensus reached in various countries as well as the most recent recommendations for an accurate diagnosis of this still underdiagnosed condition.