In Reply

The correspondence once again highlights that for the disorder “lipedema”, some aspects are not sufficiently known or that there is a lack of consensus with regard to the terminology.

Dr Herpertz comments that the prevalence is probably grossly overestimated and mentions his longstanding experience in this area. The authors can confirm that several authors assess a prevalence of 10% as possibly clearly too high (1), but no relevant evidence exists that could be referred to. Several projects (for example, the lipedema registry of the Lipedema Foundation [www.lipedema.org/registry]) are trying to determine the actual prevalence by studying representative populations, but publications are still some way off.

Furthermore, he commented that hands and feet are not always spared, and this is therefore not typical of lipedema. The peer reviewed literature published to date has not described any case series that confirmed a regular involvement of hands and/or feet. A jump in diameter on wrist and ankle, the cuff phenomenon, have, however, been described in numerous articles and according to current academic opinion, these are considered a classic indication of lipedema (2).

A more precise categorization of the Stemmer sign, as Dr Brauer rightly calls for, would have exceeded the scope of the article because of the extent of the explanations that would have needed to be added (3). We agree that a positive Stemmer sign is by no means pathognomonic for stage III lipedema, but will be positive only in a setting of accompanying lymphedema. Since the terminology “lipo-lymphedema” is somewhat controversial (lipo-lymphedema versus lipedema with secondary lymphedema versus stage IV lipedema), we did not include this in our article but instead pointed out that in stage III, the Stemmer sign may be positive (4). To correct and rephrase: “potentially Stemmer sign positive if accompanied by lymphedema.”