Artigos

Int Angiol. 2026 Nov 11. doi: 10.23736/S0392-9590.26.05571-9. Online ahead of print.ABSTRACTBACKGROUND: Lipedema is a chronic disorder of adipose and loose connective tissue characterized by a symmetrical and disproportionate fat distribution, predominantly affecting women. Despite increasing recognition, the lack of a standardized and reproducible imaging protocol limits objective diagnosis, differentiation from related conditions, and comparability across centers. Ultrasonography represents an accessible and versatile tool for evaluating subcutaneous tissue, fascial structures, and microcirculation in lipedema.METHODS: We developed an international, multidisciplinary, expert-based ultrasound protocol using a structured methodological framework. The protocol integrates standardized anatomical measurement points for the lower limbs (A-D) and upper limbs (1-6), quantitative assessment of subcutaneous thickness using validated cutoff values, qualitative evaluation of tissue architecture, and systematic analysis of superficial and deep fasciae. High-sensitivity Doppler techniques, including Micro Flow Imaging, were incorporated to assess microvascular patterns. Histological correlations were derived from previously published data from the authors’ group, supporting the interpretation of microvascular and structural findings. The protocol was constructed through integration of current literature and expert clinical experience from a multidisciplinary international group. A structured worksheet was designed to support standardized clinical and imaging data collection.RESULTS: The proposed protocol enables consistent identification of lipedema-related ultrasonographic features, including increased subcutaneous thickness, septal disorganization, nodularity, fascial thickening, reduced fascial gliding, and low-resistance microvascular flow. The use of standardized measurement points and cutoff values enhances reproducibility and supports differentiation from lymphedema, edema, obesity, and lipohypertrophy. By integrating quantitative, qualitative, and functional parameters, the protocol addresses current limitations of purely qualitative ultrasound classifications. The worksheet and cartographic approach allow systematic bilateral documentation and facilitate multicenter comparability.CONCLUSIONS: This international ultrasound protocol provides a comprehensive and standardized approach for the diagnostic assessment of lipedema, integrating subcutaneous, fascial, and microvascular parameters. It should be interpreted as an expert-informed framework intended to improve diagnostic consistency and to support future prospective validation studies. Its application may improve diagnostic accuracy, promote multicenter research, and support longitudinal monitoring and therapeutic decision-making.PMID:43012743 | DOI:10.23736/S0392-9590.26.05571-9

Aesthetic Plast Surg. 2026 Nov 10. doi: 10.1007/s00266-026-06420-y. Online ahead of print.NO ABSTRACTPMID:43009550 | DOI:10.1007/s00266-026-06420-y

Aesthetic Plast Surg. 2026 Nov 10. doi: 10.1007/s00266-026-06168-5. Online ahead of print.ABSTRACTINTRODUCTION: Lipedema mainly affects women and not infrequently causes intense pain, especially in the 30 to 41 age group.OBJECTIVE: To assess how effective lipedema reduction surgery can be in controlling the pain associated with the disease, as well as in controlling symptoms and, consequently, improving patients’ quality of life.METHODS: In this study, 26 patients with lipedema were followed up and evaluated at 3 different times: before the surgical procedure, after 6 months and after 12 months.RESULTS: It was found that the surgical procedure reduces around 50% of the pain reported at the first assessment point and can reach 100% pain reduction with the application of interdisciplinary procedures that change the patients’ lifestyles toward healthier eating routines and more active physical exercise.CONCLUSION: Lifestyle changes are fundamental to the long-term success of surgery and pain reduction, corroborating scientific knowledge that lipedema treatment should be interdisciplinary.LEVEL OF EVIDENCE IV: Evidence obtained from multiple time series with or without the intervention, such as case studies. Dramatic results in uncontrolled trials might also be regarded as this type of evidence. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .PMID:43009549 | DOI:10.1007/s00266-026-06168-5

Lymphology. 2026;59(3):140-152.ABSTRACTMultifactorial genetic diseases (as currently applicable for incompletely understood genetic conditions such as lipedema) present a polygenic architecture in which numerous common Single Nucleotide Polymorphisms (SNPs) contribute to overall risk with small summed effects. Traditional Polygenic Risk Scores (PRS) rely on GWAS-derived effect sizes, which are often unavailable or poorly transferable for understudied or rare diseases. This study proposes a summary-statistics-independent (external-GWAS-independent) pipeline for PRS construction and illustrates its application in lipedema. Our pipeline uses individual-level data (n=314; 208 cases, 106 controls) and preselected variants chosen based on biological relevance and physio-logical pathways involved. A standardized workflow includes quality control, alignment, variant calling, annotation, and genotype filtering. A linear Support Vector Machine (SVM) ranks variants by absolute weight to identify the most informative features. Ridge regression with L2 regularization is then applied to derive stable PRS weights. Model performance is evaluated using AUC, accuracy, F1 score, and Nagelkerke’s pseudo-R². Analyses of PRS distributions and predictor importance emphasize interpretability and capture weak but cumulative signals. The model achieved an AUC of 0.87 and a Nagelkerke’s pseudo-R² of 0.13, indicating meaningful capture of aggregated genetic risk. The proposed summary-statistics-independent pipeline offers a transparent and clinically interpretable strategy for PRS development in GWAS-scarce multifactorial diseases. The combined SVM-ridge strategy appears robust and 140 adaptable, with encouraging performance in lipedema and potential for translational risk stratification. These results should be considered proof-of-concept, pending external validation.PMID:43003071

JPRAS Open. 2026 Oct 21;53:57-67. doi: 10.1016/j.jpra.2026.10.014. eCollection 2027 Jan.ABSTRACTRare adipose disorders are abnormal subcutaneous adipose tissue diseases that present as a spectrum of soft tissue abnormalities that may be encountered by plastic surgeons. Presentation ranges from distinct subcutaneous masses in characteristic distributions in the body to large generalized fatty deposits. It is imperative to recognize these rare adipose disorders, as they are typically refractory to standard treatment approaches to obesity, such as weight loss, lifestyle modifications, pharmacologic therapy, and bariatric surgery. In this review, we provide a complete and updated review of lipedema, Madelung disease, familial multiple lipomatosis, and Dercum’s disease as well as present a case series highlighting our surgical approach to rare adipose disorders.PMID:42997034 | PMC:PMC13740858 | DOI:10.1016/j.jpra.2026.10.014

Metabol Open. 2026 Oct 25;32:100518. doi: 10.1016/j.metop.2026.100518. eCollection 2026 Dec.ABSTRACTBACKGROUND: Weight loss may not reliably improve symptoms or adipose tissue abnormalities in lipoedema. Whether symptom improvement during incretin-based pharmacotherapy is associated with the magnitude of weight loss is unknown.METHODS: We retrospectively analysed prospectively collected outcomes from 49 women with clinically diagnosed lipoedema treated with tirzepatide in routine care at a specialist clinic between January 2024 and May 2026. The Lipedema Symptom Assessment Questionnaire (QuASiL; range 0-150) was completed before treatment and at the most recent follow-up (3-18 months). The primary analysis examined the association between percentage weight change and percentage symptom change.RESULTS: Weight change was not significantly associated with symptom change (r = 0.058, 95% confidence interval -0.23 to 0.33; p = 0.692). Baseline-adjusted analysis of covariance agreed (weight-change β = 0.03; p = 0.890). Symptom change was also not significantly associated with dose intensity or treatment duration. In contrast, weight change was associated with dose intensity (r = -0.569) and duration (r = -0.611).CONCLUSIONS: Every participant improved by at least 30% on the QuASiL and 93.9% by at least 50%, yet no significant association was observed between symptom improvement and weight loss, dose intensity, or treatment duration, whereas weight loss showed exposure-response associations. The near-zero estimate, small sample and uniform symptom response leave a confidence interval that does not exclude small-to-moderate associations, so independence from weight loss cannot be inferred, and without a control group the improvement cannot be attributed to tirzepatide. These hypothesis-generating findings require confirmation in controlled studies with objective outcomes.PMID:42991981 | PMC:PMC13737382 | DOI:10.1016/j.metop.2026.100518

Reg Anesth Pain Med. 2026 Nov 4:rapm-2026-108036. doi: 10.1136/rapm-2026-108036. Online ahead of print.NO ABSTRACTPMID:42982518 | DOI:10.1136/rapm-2026-108036

Phlebology. 2026 Oct 30:2683555261503900. doi: 10.1177/02683555261503900. Online ahead of print.ABSTRACTBackgroundLipedema is a chronic pain disorder characterized by disproportionate adipose tissue accumulation and pain of the affected extremities. While medical compression therapy is recommended for pain reduction, evidence regarding the additional benefit of intermittent pneumatic compression (IPC) remains limited. The aim of this study was to evaluate the effect of IPC on pain in patients with lipedema already receiving compression therapy.MethodsRetrospective investigator-initiated analysis of 100 consecutive questionnaires from women with physician-diagnosed lipedema that underwent a home-based IPC trial provided by a medical device company. Pain intensity was recorded on a 0-10 numerical rating scale (NRS) before initiation of IPC and after 10-14 days of treatment. Information on (obsolete) lipedema stage, body characteristics, compression therapy and manual lymphatic drainage (MLD) was collected. Changes in pain scores were analysed.Results90 patients already receiving manual lymphatic drainage and compression garments were evaluated. Mean/median age of the participants was 48.8/48 years (SD 13.8). Mean/median body mass index was 32.1/31.2 kg/m2 (SD 6.7). 5 patients were classified as lipedema stage I, 58 stage II, 24 stage III. Prior to IPC, the mean/median pain score was 6.5/6.0 (SD 1.56), decreasing to 3.8/4 (SD 1.55) after treatment. The mean/median reduction in pain was 2.7/3.0 points (p < 0.001). No patient reported worsening of pain. The (obsolete) lipedema stages did not influence pain scores or pain reduction.ConclusionIn this cohort of patients with lipedema already receiving compression therapy and MLD the short-term intermittent pneumatic compression (IPC) use was associated with a significant reduction in self-reported pain. The observed effect was independent of (obsolete) lipedema stage. In addition to pain relief, many patients reported improvements in mobility and tissue quality. Prospective controlled studies are warranted to further evaluate the role of IPC in the management of lipedema.PMID:42960549 | DOI:10.1177/02683555261503900

Phlebology. 2026 Oct 30:2683555261504655. doi: 10.1177/02683555261504655. Online ahead of print.ABSTRACTObjectivesLipedema is a progressive adipose disorder affecting women, with diagnosis often delayed due to symptom overlap and lack of validated tools. This study assesses the Turkish version of the Lipedema Screening Questionnaire (T-LSQ) through cultural adaptation and psychometric evaluation. The aim of this study was to investigate selected psychometric properties of the Turkish version of the Lipedema Screening Questionnaire (T-LSQ).MethodsThe study involved 59 female volunteers diagnosed with lipedema/lipolymphedema by a cardiovascular surgeon. Key demographics such as age, onset age, lipedema types and stages, clinical features, and Body Mass Index were recorded. The Turkish adaptation of the LSQ was performed in accordance with the protocol of Beaton et al. Confirmatory factor analysis was performed for structural validity. Convergent construct validity was assessed by examining the correlations between T-LSQ scores and the Lower Extremity Functional Scale (LEFS), Lymphedema Life Impact Scale (LLIS), and Lymphoedema Functioning, Disability and Health Questionnaire for Lower Extremity Lymphedema (Lymph-ICF-LL). Test-retest reliability and internal consistency were also evaluated.ResultsSignificant correlations were found between the T-LSQ and the LEFS, LLIS, and Lymph-ICF-LL (r = -0.407, r = 0.613, and r = 0.548, respectively). Test-retest reliability was excellent (ICC = 0.996, 95% CI: 0.994-0.998), while Cronbach’s alpha was 0.60. CFA findings provided mixed evidence regarding structural validity.ConclusionThe Turkish version of the LSQ showed excellent test-retest reliability and evidence of convergent construct validity.PMID:42961804 | DOI:10.1177/02683555261504655

Endocrine. 2026 Oct 29;91(1):355. doi: 10.1007/s12020-026-04723-3.ABSTRACTBACKGROUND: Lipoedema and familial partial lipodystrophy (FPLD) are rare adipose tissue disorders frequently misclassified as common obesity. Clinical assessment and body mass index (BMI) alone may fail to capture regional fat distribution, delaying recognition and suboptimal management of metabolic complications.OBJECTIVE: To evaluate whether dual-energy X-ray absorptiometry (DXA)-derived regional fat distribution indices may provide complementary phenotyping information for distinguishing clinically characterized women with lipoedema, FPLD, general obesity, and normal adiposity. DXA-derived ratios and percentage fat mass were evaluated as exploratory, descriptive measures rather than definitive diagnostic markers, given known limitations of ratio-based and percentage-derived parameters.METHODS: This retrospective study included 72 women, equally allocated into four groups: lipoedema, FPLD, obesity, and normal-weight controls. All participants underwent whole-body DXA scanning to quantify total and regional fat parameters. Receiver operating characteristic (ROC) analyses assessed the discriminative performance of various indices.RESULTS: DXA revealed distinct adiposity patterns across groups. Lipoedema was best distinguished by a lower trunk fat mass (FM)/leg FM ratio (AUC: 0.964; p < 0.001). FPLD showed a centripetal fat distribution, notably via trunk FM/leg FM and trunk FM/limb FM ratios (both AUC: 0.860; p < 0.001). A total fat percentage ≥43.5% discriminated lipoedema from FPLD with near-perfect accuracy (AUC: 0.990).CONCLUSION: DXA-based assessment of regional fat distribution may provide supportive objective information for differentiating clinically selected women with lipoedema, FPLD, obesity, and normal adiposity; ratio-based and percentage-derived indices should be regarded as exploratory and hypothesis-generating rather than definitive diagnostic criteria. The applicability of these findings to male populations requires further investigation.PMID:42955484 | DOI:10.1007/s12020-026-04723-3

Phlebology. 2026 Oct 29:2683555261503904. doi: 10.1177/02683555261503904. Online ahead of print.ABSTRACTBackgroundLipedema is a chronic adipofascial disorder characterized by pain, edema and progressive functional impairment. Conservative treatment is widely recommended as first-line therapy, but evidence on its impact on disease-specific quality of life remains limited. This study evaluated changes in quality of life following 6 months of partially standardized conservative treatment in women with lipedema, using the Lipedema Symptom Assessment Questionnaire (QuASiL).MethodsThis prospective observational cohort study included 86 women with stage I-III lipedema treated at a specialized outpatient clinic. Participants underwent a multimodal conservative treatment including manual lymphatic drainage, compression therapy, exercise recommendations and pharmacological therapy when indicated. The primary outcome was change in total QuASiL score between baseline and 6 months (ΔQuASiL). A clinically meaningful improvement was defined as a ≥10 point reduction (0.5 SD). Multivariable regression analyses identified predictors of improvement.ResultsMean QuASiL score decreased from 89.9 ± 19.6 at baseline to 74.4 ± 24.7 at 6 months (mean difference -15.6; 95% CI -20.4 to -10.7; p < 0.001), corresponding to a moderate-to-large effect size (Cohen’s dz = 0.69). Clinically meaningful improvement occurred in 56.0% of participants. Baseline QuASiL score independently predicted greater improvement (β = 0.36; p = 0.011), whereas weight change, baseline BMI and age were not significant predictors. The regression model explained 11.2% of variance score change (R2 = 0.11).ConclusionsMultimodal conservative treatment was associated with statistically and clinically significant improvements in disease-specific quality of life in women with lipedema, independent of weight loss. Controlled studies are needed to establish causality and identify predictors of therapeutic response.PMID:42956381 | DOI:10.1177/02683555261503904

Curr Issues Mol Biol. 2026 Oct 7;48(10):1038. doi: 10.3390/cimb48101038.ABSTRACTAim: This narrative review summarises evidence on pathogenetic mechanisms of adipose tissue remodelling and adipokine dysregulation in lipedema, focusing on adipocyte hypertrophy and hyperplasia, fibrosis, microcirculatory and lymphatic dysfunction, immune-cell alterations, and diagnostic biomarkers. Methods: We conducted a narrative search in PubMed, Scopus, and Google Scholar from database inception to September 2026, including publications from 2001 to 2026. Search terms included “lipedema”, “lipedema adipokines”, “lipedema biomarkers”, “adipose tissue remodelling”, “fibrosis”, “adipocyte hypertrophy”, and “adipocyte hyperplasia”, combined with specific molecules. Bibliographies were screened. This review was not registered and did not follow a systematic-review protocol. Results: Lipedema involves pathological subcutaneous adipose tissue remodelling, including adipocyte hypertrophy and hyperplasia, extracellular matrix fibrosis, vascular alterations, and lymphatic dysfunction. Adipose tissue macrophages are enriched in CD163+/CD206+ populations, although the M1/M2 framework inadequately represents their heterogeneity. Individual adipokines (leptin, adipocyte-type fatty acid-binding protein) show limited diagnostic value due to dependence on total adipose mass and BMI. Multicomponent signatures (adiponectin, adipocyte-type fatty acid-binding protein, fibroblast growth factor 21, chemerin, afamin, growth and differentiation factor 15) demonstrate promising performance. Additional markers include reduced tissue adipsin expression, altered endostatin, and elevated interleukin-11, interleukin-28A, and interleukin-29. Most studies are limited by small cohorts, cross-sectional designs, inconsistent controls, obesity-related confounding, and lack of external validation. Conclusions: Lipedema involves coordinated metabolic, inflammatory, vascular, and extracellular-matrix alterations. Single adipokines are unreliable diagnostic biomarkers. Multicomponent panels may improve differentiation from obesity, but remain exploratory. Larger multicentre studies with standardised phenotyping and external validation are needed before clinical implementation.PMID:42939576 | PMC:PMC13703629 | DOI:10.3390/cimb48101038

Curr Issues Mol Biol. 2026 Oct 7;48(10):1038. doi: 10.3390/cimb48101038.ABSTRACTAim: This narrative review summarises evidence on pathogenetic mechanisms of adipose tissue remodelling and adipokine dysregulation in lipedema, focusing on adipocyte hypertrophy and hyperplasia, fibrosis, microcirculatory and lymphatic dysfunction, immune-cell alterations, and diagnostic biomarkers. Methods: We conducted a narrative search in PubMed, Scopus, and Google Scholar from database inception to September 2026, including publications from 2001 to 2026. Search terms included “lipedema”, “lipedema adipokines”, “lipedema biomarkers”, “adipose tissue remodelling”, “fibrosis”, “adipocyte hypertrophy”, and “adipocyte hyperplasia”, combined with specific molecules. Bibliographies were screened. This review was not registered and did not follow a systematic-review protocol. Results: Lipedema involves pathological subcutaneous adipose tissue remodelling, including adipocyte hypertrophy and hyperplasia, extracellular matrix fibrosis, vascular alterations, and lymphatic dysfunction. Adipose tissue macrophages are enriched in CD163+/CD206+ populations, although the M1/M2 framework inadequately represents their heterogeneity. Individual adipokines (leptin, adipocyte-type fatty acid-binding protein) show limited diagnostic value due to dependence on total adipose mass and BMI. Multicomponent signatures (adiponectin, adipocyte-type fatty acid-binding protein, fibroblast growth factor 21, chemerin, afamin, growth and differentiation factor 15) demonstrate promising performance. Additional markers include reduced tissue adipsin expression, altered endostatin, and elevated interleukin-11, interleukin-28A, and interleukin-29. Most studies are limited by small cohorts, cross-sectional designs, inconsistent controls, obesity-related confounding, and lack of external validation. Conclusions: Lipedema involves coordinated metabolic, inflammatory, vascular, and extracellular-matrix alterations. Single adipokines are unreliable diagnostic biomarkers. Multicomponent panels may improve differentiation from obesity, but remain exploratory. Larger multicentre studies with standardised phenotyping and external validation are needed before clinical implementation.PMID:42939576 | PMC:PMC13703629 | DOI:10.3390/cimb48101038

Br J Community Nurs. 2026 Nov 2;31(11):524-535. doi: 10.12968/bjcn.2026.0060. Epub 2026 Oct 26.ABSTRACTBACKGROUND: Pain and reduced mobility are common among people living with lipoedema. While well-fitting compression garments can help alleviate these symptoms, poorly fitting garments may be ineffective and contribute to significant material waste.AIMS: This survey explored compression prescription experiences of healthcare practitioners and compared them with those of people living with lipoedema.METHODS: Online surveys were completed by 373 people living with lipoedema in 2024 and 24 healthcare practitioners in 2025. Follow-up interviews were conducted with two healthcare practitioners in 2025 and one brand.RESULTS: Chronic oedema/lymphoedema nurses normally measure for, and prescribe, compression to people with lipoedema. Lower compression classes (RAL CCL1/CCL2, 18-32mmHg) were most prescribed or used. Three specialist practitioners recommended that people with lipoedema could try compressive sportswear as a first step to ascertain tolerance to compression, and the usefulness of non-medical support before prescribing.CONCLUSIONS: Greater awareness of lipoedema and access to appropriate resources are needed among general practitioners. Specialists reported confidence in measuring and prescribing compression garments, but patient satisfaction with prescribed garments was mixed. People with lipoedema similarly reported mixed satisfaction with their compression garments. Improved compression garments, designed specifically for people with lipoedema, are needed.IMPLICATIONS FOR PRACTICE: Patients suspected to have lipoedema should be referred to specialist lymphoedema clinics where available. As fitting compression garments often involves trial and error, keeping a range of sample garments in the clinic allows patients to explore fabrics, fit and comfort to determine the most appropriate option.PMID:42932247 | DOI:10.12968/bjcn.2026.0060

Br J Community Nurs. 2026 Nov 2;31(11):524-535. doi: 10.12968/bjcn.2026.0060. Epub 2026 Oct 26.ABSTRACTBACKGROUND: Pain and reduced mobility are common among people living with lipoedema. While well-fitting compression garments can help alleviate these symptoms, poorly fitting garments may be ineffective and contribute to significant material waste.AIMS: This survey explored compression prescription experiences of healthcare practitioners and compared them with those of people living with lipoedema.METHODS: Online surveys were completed by 373 people living with lipoedema in 2024 and 24 healthcare practitioners in 2025. Follow-up interviews were conducted with two healthcare practitioners in 2025 and one brand.RESULTS: Chronic oedema/lymphoedema nurses normally measure for, and prescribe, compression to people with lipoedema. Lower compression classes (RAL CCL1/CCL2, 18-32mmHg) were most prescribed or used. Three specialist practitioners recommended that people with lipoedema could try compressive sportswear as a first step to ascertain tolerance to compression, and the usefulness of non-medical support before prescribing.CONCLUSIONS: Greater awareness of lipoedema and access to appropriate resources are needed among general practitioners. Specialists reported confidence in measuring and prescribing compression garments, but patient satisfaction with prescribed garments was mixed. People with lipoedema similarly reported mixed satisfaction with their compression garments. Improved compression garments, designed specifically for people with lipoedema, are needed.IMPLICATIONS FOR PRACTICE: Patients suspected to have lipoedema should be referred to specialist lymphoedema clinics where available. As fitting compression garments often involves trial and error, keeping a range of sample garments in the clinic allows patients to explore fabrics, fit and comfort to determine the most appropriate option.PMID:42932247 | DOI:10.12968/bjcn.2026.0060

Phlebology. 2026 Oct 26:2683555261503720. doi: 10.1177/02683555261503720. Online ahead of print.ABSTRACTBackgroundLipedema is a chronic condition that is increasingly being detected and gaining public awareness; however, strongly validated therapeutic options are lacking.ObjectivesGiven need for appropriate lipedema management approaches and demand for new studies and methods, this investigation aimed to compare effects of a combined treatment consisting of extracorporeal shock wave therapy (ESWT), manual lymphatic drainage (MLD), intermittent pneumatic compression (IPC), and lifestyle recommenda-tions to a 5-week pre-treatment period prior to treatment in patients with lipedema.MethodsWe conducted a retrospective evaluation of patients undergoing a 5-week pre-treatment period with lifestyle recommendations followed by a 5-week treatment period (10 sessions) with a standardized protocol including ESWT, MLD and IPC. Circumference measurements at three designated points on the lower extremities were recorded at start and end of pre-treatment period and before and after treatment.ResultsData from 55 female patients (age: 46.9 ± 11.9 years; body mass index: 29.54 ± 7.33 kg/m2) who completed both the 5-week pre-treatment lifestyle-only observation period and the subsequent 5-week combined treatment period were analyzed. Comparison of changes in lower extremity circumference measurements between the two periods demonstrated significantly greater reductions during the combined treatment period at five of the six evaluated measurement sites.(p < 0.05).ConclusionIn this retrospective cohort study, combined use of ESWT, MLD, IPC, and lifestyle recommendations was associated with improvements in lower extremity circumference measurements; however, due to its non-randomized design, causal inferences cannot be made. Further randomized controlled trials are needed to clarify individual and combined effects of these treatments.PMID:42933366 | DOI:10.1177/02683555261503720

Cureus. 2026 Sep 24;18(9):e116856. doi: 10.7759/cureus.116856. eCollection 2026 Sep.ABSTRACTBACKGROUND: The clinical course of lipedema in women receiving hormonal treatment for concomitant estrogen-dependent gynecological disorders remains insufficiently characterized. This study aimed to describe gynecological and lipedema-related manifestations during routine follow-up in women receiving subcutaneous gestrinone implants for gynecological indications.METHODS: This retrospective, descriptive case series included 50 women with stage II or III lipedema and concomitant estrogen-dependent gynecological disorders treated between May 2024 and May 2025 at a specialized multidisciplinary outpatient clinic in São Paulo, Brazil. Participants received two biodegradable subcutaneous gestrinone implants (35 mg and 50 mg; total dose: 85 mg) exclusively for gynecological indications. Clinical outcomes were extracted retrospectively from medical records and analyzed descriptively. Improvement proportions were calculated using the number of patients presenting each manifestation at baseline as the denominator. Outcomes were based on patient reports and qualitative clinical assessments without standardized instruments.RESULTS: Among gynecological manifestations, improvement was documented in 43 of 50 patients with menstrual pain (86%), six of 13 with menorrhagia (46.2%), and two of 50 with premenstrual symptoms (4%). Among lipedema-related manifestations, improvement was documented in 35 of 39 patients with edema (89.7%) and 33 of 41 with spontaneous pain (80.5%). Qualitative improvement in skin appearance and clinically assessed tissue fibrosis was documented in 31 of 50 (62%) and 28 of 50 (56%) patients, respectively. Overall clinical status was reported as improved by 42 patients (84%), stable by six (12%), and worsened by two (4%).CONCLUSIONS: Improvements in pain and edema, alongside qualitative changes in skin appearance and clinically assessed tissue fibrosis, were documented during routine follow-up. Given the retrospective design, absence of a comparison group, and nonstandardized assessments, these observations cannot be attributed to gestrinone or interpreted as evidence of its efficacy for lipedema. Prospective controlled studies using standardized outcome measures are warranted.PMID:42927387 | PMC:PMC13695495 | DOI:10.7759/cureus.116856

Front Glob Womens Health. 2026 Oct 9;7:1917274. doi: 10.3389/fgwh.2026.1917274. eCollection 2026.ABSTRACTBACKGROUND: There are no validated Norwegian disease-specific patient-reported outcome measures (PROMs) assessing quality of life (QoL) in females with lipedema, limiting evaluation of treatment effect in clinical practice and research.OBJECTIVE: To translate and validate a Norwegian translation of the LIPQOL questionnaire.METHODS: A cross-sectional validation study was performed in 432 females with lipedema in Norway. Descriptive statistics and floor and ceiling effects were assessed. The psychometric properties of the questionnaire were assessed using confirmatory factor analysis (CFA). The overall goodness of fit was evaluated using the root mean square error of approximation (RMSEA), the comparative fit index (CFI) and the Tucker-Lewis index (TLI). Internal consistency was assessed using composite reliability from the CFA. Associations between LIPQOL subscales and RAND-12 physical component score (PCS) and mental component score (MCS) were examined using Spearman correlations.RESULTS: The LIPQOL questionnaire comprises four subscales, Function, Body image, Symptoms, and Feelings. No subscales was affected by floor or ceiling effects. The unmodified CFA shows CFI = 0.929, TLI = 0.922, standardized root mean square residual (SRMR) = 0.073, and RMSEA = 0.079 (90% CI: 0.073 to 0.084). All composite reliability were considered reasonable (ranged from 0.890 to 0.916). Modification indices were evaluated, and two modifications were performed between items 5 and 8, and between items 17 and 18. With modification indices, the overall structure validity showed reasonable, but not unequivocally support for the four factor structure with CFI = 0.944, and TLI = 0.938, SRMR = 0.068, and RMSEA = 0.070 (90% CI: 0.064 to 0.075). Correlation between RAND-12 and LIPQOL subscales were large. Function, Symptoms, and overall quality of life show large correlation with PCS (Spearman’s rho = -0.682, Spearman’s rho = -0.550, and Spearman’s rho = 0.554, respectively) and the subscales feelings and overall quality of life shows large correlation with MCS from RAND-12 (Spearman’s rho = -0.685 and 0.608, respectively).CONCLUSION: Initial findings suggest that the Norwegian version of the LIPQOL is a reasonably valid instrument for assessing quality of life in females with lipedema, although the findings do not provide unequivocal support for all aspects of its measurement properties.PMID:42921064 | PMC:PMC13692784 | DOI:10.3389/fgwh.2026.1917274

Cureus. 2026 Sep 23;18(9):e116779. doi: 10.7759/cureus.116779. eCollection 2026 Sep.ABSTRACTPURPOSE: This study aimed to compare 12-week changes in body composition and anthropometric parameters between standard-dose and lower-dose tirzepatide escalation regimens in women with lipedema, with particular emphasis on changes in fat mass and skeletal muscle mass.PATIENTS AND METHODS: This retrospective observational study included 100 women with lipedema receiving tirzepatide during routine clinical care. Participants were classified into lower-dose (n = 50) and standard-dose (n = 50) groups according to their prescribed dosing regimens, which differed in cumulative drug exposure. Body composition, anthropometric measurements, and skinfold thickness were assessed at baseline and after 12 weeks. An exploratory composite responder criterion was defined as a ≥5% reduction in fat mass combined with a <5% reduction in skeletal muscle mass, as estimated by bioelectrical impedance analysis (BIA). Between-group comparisons were unadjusted.RESULTS: Both regimens were associated with reductions in body weight, fat mass, and body fat percentage (all within-group p < 0.001). No statistically significant between-group differences were detected in these changes. The lower-dose regimen was associated with a smaller reduction in BIA-estimated skeletal muscle mass than the standard-dose regimen (-0.7 vs. -2.0 kg; p < 0.001). The exploratory composite responder criterion was met by 68% (34/50) of participants in the lower-dose group and 22% (11/50) in the standard-dose group (OR = 7.53; 95% CI: 3.08-18.44; p < 0.001). No statistically significant between-group differences were detected in anthropometric measurements or skinfold thickness changes.CONCLUSION: Both tirzepatide dosing regimens were associated with reductions in body weight and adiposity in women with lipedema. The lower-dose regimen was associated with a smaller reduction in BIA-estimated skeletal muscle mass and a higher proportion of participants meeting the exploratory composite responder criterion. These findings require confirmation in prospective controlled studies, given the non-randomized design, differences in cumulative drug exposure, and potential residual confounding.PMID:42921232 | PMC:PMC13693571 | DOI:10.7759/cureus.116779

Phlebology. 2026 Oct 24:2683555261499760. doi: 10.1177/02683555261499760. Online ahead of print.ABSTRACTIntroductionLipedema is a chronic adipose and connective tissue disorder in which pain is classically localized to affected limb tissue. However, some patients report joint, periarticular, myotendinous, or axial pain, with fatigue, sleep disturbance, and exercise intolerance. When symptoms become widespread, the presentation may resemble fibromyalgia (FM), creating a diagnostic challenge for phlebologists.ObjectivesTo provide a clinical framework for distinguishing characteristic lipedema tissue pain from musculoskeletal pain generators, secondary central pain amplification, and potentially coexisting FM.MethodsThis narrative review was conducted with reference to the Scale for the Assessment of Narrative Review Articles (SANRA). PubMed, Scopus, and Google Scholar were searched through May 2026 for studies addressing lipedema, FM, widespread pain, hypermobility, connective tissue vulnerability, biomechanical dysfunction, and pain sensitization. Reference lists were manually screened. No formal risk-of-bias assessment or quantitative synthesis was performed.ResultsCharacteristic lipedema pain is predominantly localized to affected adipose tissue and associated with tenderness, pressure sensitivity, easy bruising, and functional impairment. Observational studies have also reported joint and periarticular pain, axial symptoms, hypermobility, and biomechanical dysfunction in patient subsets. Extra-adipose pain should be assessed separately and not automatically attributed either to lipedema or independent FM. Tissue hypersensitivity, stromal and microvascular alterations, joint instability, and altered biomechanics may represent peripheral pain generators contributing to secondary central amplification. However, observational evidence does not establish whether widespread pain is intrinsic to lipedema, secondary to musculoskeletal dysfunction or central amplification, or reflects coexisting FM.ConclusionsIn patients with lipedema and extra-adipose or widespread pain, phlebologists should assess joint hypermobility, instability, biomechanical dysfunction, and axial or musculoskeletal pain. FM criteria identify a widespread pain phenotype but cannot determine whether it represents an independent comorbidity or is related to persistent peripheral nociceptive mechanisms. Multidisciplinary assessment may improve diagnostic characterization and individualized management.PMID:42921698 | DOI:10.1177/02683555261499760

Front Immunol. 2026 Oct 8;17:1837973. doi: 10.3389/fimmu.2026.1837973. eCollection 2026.ABSTRACTRATIONAL: Steroid-insensitive type 2 cytokine-producing CD8+ T cells (Tc2) are enriched in patients with severe asthma and correlate with disease severity, highlighting their potential role as drivers of treatment-refractory disease. The molecular mechanisms governing their functional differentiation remain incompletely understood.METHODS: Mouse CD8+ T cells were differentiated in vitro under type 1 or type 2 polarizing conditions. Genome-wide transcriptional and H3 histone acetylation profiles were analyzed using RNA sequencing and chromatin immunoprecipitation (ChIP) sequencing. Both were integrated to identify H3Ac-associated transcriptional programs. Functional consequences of pharmacologic inhibition of histone acetyltransferase (HAT) activity in Tc2 cells were assessed after adoptive transfer into allergen-sensitized CD8-deficient mice. In parallel, transcriptomic profiling of human CD8+ T cells from healthy individuals and steroid-resistant asthmatics was performed and integrated with the mouse Tc2 dataset to identify conserved regulatory pathways.RESULTS: Tc1 and Tc2 differentiation were characterized by coordinated transcriptional remodeling with distinct type 2-associated networks emerging in response to IL-4 and T cell receptor stimulation including Il-24, Cyp11a1, and Il-13. Integration of histone acetylation data and transcriptional networks identified condition-specific H3Ac-associated differentially-expressed genes (DEGs) and functional programs specific to Tc1 and Tc2 cells. While H3Ac-associated DEGs in Tc1 cells were linked predominantly to broader inflammatory and immune effector pathways, this integrative approach showed an enrichment of type 2 immune pathways in Tc2 cells. Pharmacologic modulation of HAT activity increased Tc2 cytokine responses and enhanced the pathogenic effects of Tc2 cells in vivo, resulting in heightened airway hyperresponsiveness and eosinophilic inflammation. Human CD8+ T cells from steroid-resistant asthmatics exhibited distinct transcriptional profiles compared with healthy individuals, including increased IL-13 expression. Cross-species integration revealed significant overlap between mouse Tc2 transcriptional signatures and gene networks in steroid-resistant asthmatics.CONCLUSION: These findings propose coordinated epigenetic and transcriptional remodeling as a central mechanism regulating functional differentiation of Tc2 cells. They further define shared molecular pathways linking CD8+ T cell programming to type 2 inflammation in severe asthma, providing insight into mechanisms that may contribute to persistent disease and therapeutic resistance.PMID:42923234 | PMC:PMC13687325 | DOI:10.3389/fimmu.2026.1837973

Phlebology. 2026 Oct 23:2683555261499792. doi: 10.1177/02683555261499792. Online ahead of print.ABSTRACTBackgroundChronic venous disorders and lipedema are complex and frequently underdiagnosed conditions characterized by heterogeneous clinical presentations, progressive tissue remodeling, and substantial variability in treatment response assessment. Despite advances in minimally invasive vascular interventions, longitudinal evaluation in routine clinical practice continues to rely heavily on subjective interpretation, non-standardized comparative imaging, and physician-dependent assessment pathways. The integration of multimodal vascular data into structured longitudinal clinical workflows remains limited.ObjectiveThis study introduces the LipoVena AI Framework, a physician-centered conceptual artificial intelligence-assisted clinical support architecture designed to facilitate multimodal integration, longitudinal treatment-response evaluation, and personalized monitoring in lipedema and chronic venous disease management.MethodsA retrospective observational clinical dataset consisting of 32 patients with chronic venous insufficiency, lipedema, reticular veins, spider veins, and mixed venous-lymphatic phenotypes was reviewed. Standardized standing-position photography, duplex ultrasound imaging, procedural documentation, and longitudinal 1-month follow-up assessments were integrated within a conceptual AI-assisted workflow. Representative patients underwent multimodal minimally invasive treatment strategies including endovenous laser therapy (EVLT), CLACS-guided sclerotherapy, radiofrequency-based tissue remodeling, and compression therapy. The proposed framework conceptually integrates multimodal imaging analysis, vascular mapping, comparative longitudinal assessment, and physician-supervised AI-assisted interpretation.ResultsRepresentative 1-month follow-up observations demonstrated visible improvements in contour harmonization, superficial venous prominence, tissue irregularity, skin texture uniformity, and vascular burden across multiple venous and lipedema phenotypes. Comparative multimodal analysis integrating clinical photography and duplex ultrasound findings enabled structured longitudinal assessment of therapeutic response patterns. Upper-extremity lipedema cases additionally demonstrated measurable contour and tissue-texture improvement following multimodal treatment strategies. The proposed framework illustrated the potential role of AI-assisted longitudinal comparison and multimodal integration in supporting objective treatment-response evaluation within physician-centered vascular care workflows.ConclusionThe LipoVena AI Framework presents a conceptual translational model for future AI-assisted vascular and lipedema medicine by integrating standardized clinical imaging, duplex ultrasound evaluation, multimodal treatment documentation, and longitudinal follow-up analysis within a physician-centered ecosystem. Although prospective multicenter validation and quantitative AI modeling remain necessary, the present framework highlights the potential of explainable and physician-supervised artificial intelligence systems to support personalized, data-driven, and longitudinally optimized vascular care.PMID:42925123 | DOI:10.1177/02683555261499792

MMW Fortschr Med. 2026 Oct;168(18):48-50. doi: 10.1007/s15006-026-6295-y.NO ABSTRACTPMID:42919066 | DOI:10.1007/s15006-026-6295-y

Front Cell Dev Biol. 2026 Oct 7;14:1808579. doi: 10.3389/fcell.2026.1808579. eCollection 2026.ABSTRACTBACKGROUND: Lipedema is a chronic adipose tissue disorder characterized by a disproportionate accumulation of painful subcutaneous fat on the extremities. Manual lymphatic drainage (MLD) is routinely used as therapeutic intervention, but its immediate physiological effects remain unclear. We evaluated the immediate impact of MLD on tissue composition in Lipedema using multiparametric Magnetic-resonance-imaging (MRI).MATERIALS AND METHODS: Fifteen women with Lipedema (5 women each for stages I/II/III; median age 43.7 [20.4-68.8] years), thirteen with lower-limb lymphedema (3/5/5 women for stages I/II/III; median age 57.6 [18.6-70.4] years) underwent quantitative MRI of the legs including volumetry, sodium MRI, proton-densitiy fat-fraction (PDFF), T1, T2 and fat-suppressed T2 mapping before and after a standardized 1 h MLD session. Five normal controls (median age 41.9 [23.3-66.2] years) were examined only before MLD. Regions of interest in skin, subcutaneous adipose tissue (SAT), and muscle were analyzed. Pain was assessed by numeric rating scale (NRS). Wilcoxon tests and Spearman correlations were applied to test for differences pre- and post-MLD as well as for associations between measurements and clinical parameters (p < 0.05).RESULTS: At baseline, women with Lipedema showed higher tissue sodium and water-sensitive MRI measures compared to controls (skin sodium: median 17.7 vs. 12.3 mmol/L, p < 0.001; skin T2: 56 vs. 37 ms, p = 0.03), though lower than lymphedema (skin sodium: 32.1 mmol/L, skin T2: 70 ms). Tissue sodium in women with Lipedema correlated with clinical stage (r = 0.775, p = 0.001) and pain intensity (r = 0.656, p = 0.01). After MLD, perceived pain intensity decreased (median NRS 2 → 0, p = 0.007) and edema-related MRI metrics including tissue sodium decreased in women with Lipedema (skin sodium: 17.7 → 14.8 mmol/L, p = 0.001; skin T2: 56 → 43 ms, p = 0.001). Parameter changes in the same direction after MLD were detected in women with Lymphedema (skin sodium: 32.1 → 27.1 mmol/L, p = 0.001; skin T2: 70 → 61 ms, p = 0.001).CONCLUSION: Manual lymphatic drainage produces immediate, quantifiable changes in treated tissue in women with lipedema, indicating mobilization of sodium-rich interstitial fluid.PMID:42909292 | PMC:PMC13684812 | DOI:10.3389/fcell.2026.1808579

Rev Assoc Med Bras (1992). 2026 Oct 16;72(9):e20260760. doi: 10.1590/1806-9282.20260760. eCollection 2026.ABSTRACTOBJECTIVE: The aim of this study was to characterize global scientific output on lipedema from 2000 to 2025 and identify emerging thematic trends, with emphasis on the emergence of immunological research.METHODS: Publications indexed in Google Scholar, PubMed, Crossref, OpenAlex, and Scopus were retrieved using the terms “lipedema” OR “lipoedema.” Records were deduplicated by normalized title matching and DOI cross-referencing. Bibliometric indicators computed included publication volume, citation metrics, field h-index, exponential growth rate, geographic distribution, author metrics, specialty classification (journal-name keyword matching supplemented by OpenAlex concept tags), and immunological content (regular-expression pattern matching against a predefined term list).RESULTS: A total of 942 unique publications were identified, accumulating 13,688 citations (field h-index=60; mean 14.5 citations per article; median 2 citations per article). Annual output grew from below 12 per year through 2009 to 145 in 2025, with a doubling time of 3.6 years (R2=0.90; p<0.001). The United States, Germany, and Brazil were the most productive countries. Karen Lynn Herbst (USA) was the most influential researcher (46 papers; h-index=20; 1,586 citations). Lymphology and phlebology formed the dominant classifiable domain (17.1%), with 69.3% of publications spanning multiple disciplines. Publications with immunological content totaled 30 (3.2%), grew from essentially zero before 2019 to 4.8% of annual output in 2025, and received higher mean citations than non-immunological articles (16.6 vs. 14.5).CONCLUSION: Lipedema research is undergoing rapid exponential expansion driven by growing global recognition of a historically neglected condition. The accelerating immunological trend, with consistently higher citation impact, indicates an accelerating paradigm shift toward chronic adipose tissue inflammation as a unifying pathophysiological framework.PMID:42912067 | PMC:PMC13674950 | DOI:10.1590/1806-9282.20260760