The Prevalence Was Probably Overestimated

The authors presented a comprehensive search of the English language literature on lipedema (1). I wish to comment on two points, as a search of the German language literature would have yielded different results.

The prevalence of lipedema was found to be some 10% in the female population. For Germany this would mean that 4.5 million women are affected by lipedema. The reason for the purported prevalence is the lacking differentiation of lipedema (painful) from painless lipohypertrophy and obesity. This differentiation has been known in Germany since 1993 (2). It prevents pointless complex decongestive therapy and thus a waste of health insurers‘ financial resources because complex decongestive therapy or physical edema therapy is indicated only in lipedema (3). In my estimation based on many years of lymphologist activity, the number of patients with genuine lipedema in Germany is about 100 000.

It is incorrect to assume generally that hands and feet are spared from the proliferation of fatty tissues. In lipohypertrophy and lipedema of the arms I also found hypertrophy of fatty tissues on the hands and fingers in 23% and in lipohypertrophy and lipedema of the legs, feet and toes, in 5% of cases (author’s own data). These fatty deposits usually do not cause any problems, as in lipedema, but they are responsible for diagnostic misclassifications as they are erroneously categorized as lipo-lymphedema.