Artigos

Front Cell Dev Biol. 2026 Sep 15;14:1893868. doi: 10.3389/fcell.2026.1893868. eCollection 2026.ABSTRACTINTRODUCTION: Low-carbohydrate diets (LCDs) have been suggested as a potential treatment option for females with lipedema, due to their superiority in reducing pain, possibly through improvements in insulin dynamics.OBJECTIVES: The objective of this secondary analysis was to compare changes in markers of glucose and insulin dynamics after a low-carbohydrate versus low-fat low-energy diets in females with lipedema and obesity. A secondary objective was to investigate potential associations between changes in glucose and insulin dynamics and changes in pain.METHODS: Females with obesity and lipedema were randomized to either an LCD or a low-fat low-energy diets (1200 kcal/day for both; 75 vs. 180 g carbohydrates/day) for 8 weeks. Basal and postprandial (total and incremental area under the curve (tAUC and iAUC)) concentrations of glucose, insulin, glucose-dependent insulinotropic polypeptide (GIP), and C-peptide were measured before and after the intervention, and HOMA-IR, Matsuda index and insulin clearance calculated.RESULTS: A total of 70 females (35 in each group, age 47 ± 11 years, BMI 37 ± 5 kg/m2) were included in the analysis. Both groups lost body weight, but with a significantly greater weight loss in the LCD group. Both groups showed ed a reduction in basal glucose, C-peptide, and insulin concentrations, with a greater reduction in glucose on the LCD. A significant increase in glucose iAUC, C-peptide iAUC, insulin clearance, and Matsuda index was observed in the LCD group only. Both groups experienced an increase in GIP tAUC, as well as a reduction in HOMA-IR, with no significant differences between groups. No associations were seen between changes in glucose and insulin measures and changes in pain.CONCLUSION: Both diets improved insulin dynamics in females with lipedema and obesity, despite additional benefits in the LCD group. However, changes in the measured indices of insulin dynamics were not associated with pain reduction, suggesting that the effects of the LCD on pain and systemic metabolic regulation may involve other pathways.PMID:42812451 | PMC:PMC13619572 | DOI:10.3389/fcell.2026.1893868

Aesthetic Plast Surg. 2026 Sep 28. doi: 10.1007/s00266-026-06279-z. Online ahead of print.ABSTRACTOBJECTIVE: The aim of this study was to compare serum adiponectin, leptin, resistin, irisin, and galectin-3 levels between patients with lipedema and healthy controls, and to examine their relationship with subcutaneous adipose tissue thickness.METHODS: In this cross sectional case control study, 40 female patients with lipedema and 36 age and body mass index matched healthy controls were included. Serum levels of adiponectin, leptin, resistin, irisin, and galectin-3 were measured using enzyme-linked immunosorbent assay. Subcutaneous adipose tissue thickness was assessed by ultrasonography at predefined anatomical sites. Pain intensity, functional status, and quality of life were evaluated. Correlation analyses were performed to investigate associations between biomarkers and ultrasonographic findings.RESULTS: Serum adiponectin, leptin, resistin, irisin, galectin-3, and routine biochemical parameters did not differ significantly between groups (all p > 0.05). Subcutaneous adipose tissue thickness was significantly higher in all measured regions in the lipedema group (p < 0.001). Biomarker levels did not differ according to lipedema stage (all p > 0.05). Among the evaluated biomarkers, only serum leptin showed a weak positive correlation with anterior thigh subcutaneous adipose tissue thickness (rho = 0.399, p = 0.014). In secondary comparisons, patients with lipedema reported higher pain scores and lower functional capacity and quality of life (all p < 0.05).CONCLUSION: Serum adiponectin, leptin, resistin, irisin, and galectin-3 levels were similar between patients with lipedema and healthy controls despite significantly increased subcutaneous adipose tissue thickness. Only leptin showed a weak positive correlation with anterior thigh subcutaneous adipose tissue thickness. These findings suggest that circulating biomarkers may not adequately reflect local adipose tissue alterations in lipedema. Further studies are needed to clarify their role in the pathophysiology of lipedema.LEVEL OF EVIDENCE III: 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:42806128 | DOI:10.1007/s00266-026-06279-z

Curr Issues Mol Biol. 2026 Sep 1;48(9):892. doi: 10.3390/cimb48090892.ABSTRACTLipedema and obesity are often misdiagnosed or clinically confused yet arise via distinct mechanisms, complicating diagnosis and treatment. This review synthesizes evidence differentiating these conditions across genetic, hormonal, inflammatory and mechanical pathways to identify therapeutic targets. Lipedema may involve genetic predisposition (forkhead box C2 [FOXC2], prospero homeobox 1 [PROX1]), hormonal dysregulation with aberrant aromatase activity, and altered adipogenesis (peroxisome proliferator-activated receptor gamma [PPARγ], CCAAT/enhancer-binding protein [C/EBP]). A proinflammatory microenvironment with macrophage M1/M2 imbalance, elevated interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α), and extracellular matrix remodeling is hypothesized to drive fibrosis. Emerging evidence implicates gut-derived endotoxemia (lipopolysaccharide [LPS]-toll-like receptor 4 [TLR4]-nuclear factor kappa-B [NF-κB]) and mechanotransduction (Yes-associated protein [YAP]/transcriptional coactivator with PDZ-binding motif [TAZ]) in adipocyte hypertrophy and treatment resistance. Obesity involves systemic metabolic dysfunction with visceral adiposity and cardiometabolic comorbidities. Lipedema patients maintain metabolic health, exhibit gluteofemoral fat distribution and experience neuropathic pain via nociceptor sensitization (transient receptor potential vanilloid 1 [TRPV1] and ankyrin 1 [TRPA1]) with central amplification. Weight-loss interventions are ineffective, necessitating targeted strategies. Promising targets include TLR4 antagonism, vascular endothelial growth factor C/vascular endothelial growth factor receptor-3 (VEGF-C/VEGFR3) modulation for lymphatic enhancement, YAP/TAZ inhibition and neuromodulators for pain. Physical therapy functions as a biological modifier targeting inflammation, lymphatic drainage and mechanotransduction. This review highlights promising but largely hypothesis-generating molecular insights and calls for validated biomarkers, rigorous clinical trials, and mechanism-based therapies. Many of the pathways discussed require further confirmation in human studies.PMID:42793248 | PMC:PMC13605479 | DOI:10.3390/cimb48090892

Life (Basel). 2026 Sep 2;16(9):1471. doi: 10.3390/life16091471.ABSTRACTBACKGROUND: Lipedema is a chronic progressive condition affecting approximately 10% of women, characterized by disproportionate subcutaneous adipose tissue accumulation and pain in the lower extremities. Standardized assessment methods for pain evaluation in lipedema remain limited. The Progressive Pain Check (PPC) method represents a potentially valuable tool for standardized pain assessment in lipedema patients.OBJECTIVE: To evaluate the inter-rater reliability of the PPC method for clinical assessment of evoked pain in lipedema patients.METHODS: Two independent assessors performed PPC evaluations. Inter-rater reliability was assessed using the Intraclass Correlation Coefficient [ICC(2,1), two-way random-effects, absolute agreement, single-measurement] with 95% confidence intervals (CI).RESULTS: This study included 429 women diagnosed with lipedema (mean age 41.2 ± 11.5 years, mean disease duration 27.2 ± 12.6 years). Patient characteristics revealed mean BMI of 29.5 ± 6.9 kg/m2, predominantly Type III lipedema presentation, and disease onset during adolescence (mean age 14 ± 9.3 years). The PPC method demonstrated excellent inter-rater reliability between two independent assessors across all examined anatomical districts.CONCLUSIONS: The PPC method shows promise as a simple, repeatable, and standardized clinical tool for evoked pain assessment in lipedema patients. The demonstrated inter-rater reliability supports its potential utility in clinical practice. Further research is warranted to evaluate its intra-rater reliability, concurrent validity, and responsiveness in monitoring treatment effects.PMID:42795335 | PMC:PMC13608010 | DOI:10.3390/life16091471

Am J Phys Med Rehabil. 2026 Sep 24. doi: 10.1097/PHM.0000000000003164. Online ahead of print.ABSTRACTOBJECTIVE: To compare the efficacies of extracorporeal shock wave therapy (ESWT) and complex decongestive therapy (CDT) in patients with lipedema.DESIGN: This randomized-controlled-study included 33 patients with lipedema, with 11 patients in each of the three groups. The first group received ESWT alone, the second group received CDT alone, and the third group received ESWT followed by CDT within the session for six treatment sessions. Assessments were performed at baseline and two weeks after treatment completion. Outcome measures included total and lower extremity fat mass assessed using dual-energy X-ray absorptiometry, lower extremity volume, body mass index, pain intensity, pressure pain threshold, and quality of life.RESULTS: Total and lower extremity fat mass decreased significantly only in the ESWT and ESWT+CDT groups (P<0.05), although the magnitude of improvement was small and not superior to that of CDT alone (P>0.05). Additionally, all three groups showed significant improvements in lower extremity volume, pain intensity, pressure pain threshold, and quality of life (P<0.05), with no significant differences between the groups (P>0.05).CONCLUSION: All three treatment approaches are safe and feasible options for the management of lipedema. Considering its low cost, accessibility, and ease of application, ESWT may be preferred over the other treatment modalities.PMID:42785926 | DOI:10.1097/PHM.0000000000003164

Phlebology. 2026 Sep 23:2683555261490374. doi: 10.1177/02683555261490374. Online ahead of print.ABSTRACTBackgroundLipedema is a frequently misdiagnosed chronic condition that significantly impacts patients’ quality of life. As artificial intelligence (AI)-based large language models (LLMs) become increasingly integrated into healthcare communication, their accuracy and consistency in providing patient-centered information require thorough evaluation, especially in rare diseases like lipedema. Therefore, this study aimed to evaluate the accuracy and reproducibility of responses generated by ChatGPT, DeepSeek, and Gemini to questions frequently asked by patients with lipedema.MethodsThis cross-sectional study assessed the accuracy and reproducibility of responses generated by ChatGPT, DeepSeek, and Gemini to 25 commonly asked lipedema-related questions. Each model was queried twice in separate sessions, and answers were evaluated by three independent experts using a four-point rating scale. To ensure the objectivity and consistency of expert evaluations, inter-rater agreement was assessed using Cohen’s kappa coefficient.ResultsDeepSeek achieved the highest proportion of comprehensive and correct responses (72%), followed by Gemini (64%) and ChatGPT (56%). Accuracy varied across content categories, with notable limitations particularly in treatment, follow-up, and maintenance questions. Reproducibility analysis revealed that DeepSeek produced the most consistent responses across sessions, while ChatGPT and Gemini showed more variability, particularly in treatment and quality-of-life questions. Cohen’s kappa values indicated high inter-rater agreement overall, with perfect agreement in some categories for ChatGPT and DeepSeek.ConclusionsLLMs can provide generally accurate and consistent responses to patient-centered questions about lipedema, particularly in areas related to general information and diagnosis. However, reduced accuracy and reproducibility in complex clinical domains suggest that expert oversight is essential when using these tools for patient education.PMID:42776843 | DOI:10.1177/02683555261490374

Phlebology. 2026 Sep 21:2683555261487488. doi: 10.1177/02683555261487488. Online ahead of print.ABSTRACTIntroductionAfter unification of diagnostic criteria for lipedema through guidelines and consensus documents as a fat-disproportion between abdomen and extremities with pain in the affected area, reduced by compression, expensive treatment options like liposuction should be reserved to affected women. Whilst the diagnosis of lipedema is obviously clinic, technical investigations or clear cut-offs shall help avoiding misuse of resources. The aim of this study was to find differentiation criteria between lipedema (LIP) controls (CO).MethodsInvestigator initiated exploratory investigation of 20 women per group, with interim analysis after completion of investigation of 10 women per group. 14 LIP and 12 CO were investigated with QOL-questionnaires (CIVIQ and Lymph), Wunstorf-Vein-Office anamnesis questionnaire, Visual Analogue Scale (VAS) of spontaneous pain, Pain under manual investigation, pain under compression cuffs, ultrasound of skin and subcutaneous fat tissue, share-wave-elastography, water content of skin (LymphScanner) and stiffness of skin (FibroScanner).ResultsStatistical evaluation between LIP and CO presented significant differences for all parameters excepting share-wave-elastography, water content and stiffness of the skin. Differences between controls and Lipedema were achieved with p < .0001 for the Wunstorf-Vein-Questionnaire, with p < .001 for CIVIQ (cut-off >40 Points for LIP), compression cuff (cut-off <60mmHG), with p < .01 Skin thickness (skin lateral thigh >2.1 mm in LIP), fat tissue thickness (ankle >18 mm).ConclusionThis first analysis could establish a series of clear cut-off values between lipedema and controls for medical history parameters (existence of pain and compliance with compression garments), pain sensitivity to palpation and pressure, and the results of at least one quality-of-life questionnaire (CIVIQ better than Lymph-QOL) and promising cut-offs for objective, technically measurable parameters, such as skin and subcutaneous fat thickness. The possibility to discriminate between lipedema and lipohypertrophy will be assessed in the second part of the investigation.PMID:42766118 | DOI:10.1177/02683555261487488

Clin Obes. 2026 Oct;16(5):e70115. doi: 10.1111/cob.70115.ABSTRACTLipoedema is a painful adipose tissue disorder marked by disproportionate limb fat and often misclassified as generalized obesity or lymphoedema. This review examines its metabolic phenotype and implications for cardiometabolic assessment and management. PubMed/MEDLINE was searched from inception through May 2026 for studies on lipoedema, obesity, body composition, metabolic risk, insulin resistance, diabetes, lifestyle interventions, pharmacotherapy and liposuction. Relevant clinical, mechanistic, review and consensus literature was narratively synthesized. Evidence is limited and heterogeneous, consisting mainly of observational cohorts, referral-centre series, mechanistic studies and consensus guidance, predominantly involving women. Some studies report fewer metabolic abnormalities in women with lipoedema than in women with BMI-matched lifestyle-related overweight or obesity. These findings do not establish metabolic protection and may reflect differences in central adiposity, disease stage, diagnostic criteria, body composition, inflammation or referral patterns. Obesity and glucose-lowering therapies, including glucagon-like peptide-1 receptor agonists, remain appropriate for established indications, but direct modification of lipoedema has not been demonstrated. Cardiometabolic risk in lipoedema should be assessed using a phenotype-based approach that distinguishes painful limb adiposity from central and ectopic fat while considering age, sex, menopausal status and established risk factors. BMI should be interpreted with waist measures, metabolic screening, body composition and muscle mass when relevant. Prospective studies using standardized diagnostic criteria, direct measures of insulin sensitivity, detailed body composition and clinically meaningful outcomes are needed to clarify long-term risk and distinguish lipoedema biology from coexisting central obesity.PMID:42767624 | PMC:PMC13593362 | DOI:10.1111/cob.70115

Cureus. 2026 Aug 19;18(8):e114807. doi: 10.7759/cureus.114807. eCollection 2026 Aug.ABSTRACTHyperechoic subcutaneous nodules in lipedema may mimic angiolipomas but represent an inflammatory and hypoxic-ischemic process rather than a neoplasia, despite tissue expansion. As the painful nodules expand, biopsy is recommended to exclude cancer. In this context, ultrasound (US) has become a pivotal tool for diagnosing and managing these nodules when combined with histopathologic assessment. However, many professionals in the field still have limited knowledge of this topic. In the present case series, the US and histopathologic findings of hyperechoic nodules in two patients with lipedema were compared with those observed in two patients with angiolipoma, with the aim of proposing US criteria to distinguish between these entities and highlighting the importance of accurate differential diagnosis.PMID:42761997 | PMC:PMC13588607 | DOI:10.7759/cureus.114807

Int J Qual Stud Health Well-being. 2026 Dec 31;21(1):2734666. doi: 10.1080/17482631.2026.2734666. Epub 2026 Sep 18.ABSTRACTPURPOSE: Individuals with lipoedema may experience negative impacts that are not often identified through current quality-of-life measures. The aim of this study was to explore the experiences of individuals living with pre-existing lipoedema and their perceptions of how these experiences influence quality of life.METHODS: Participants with a prior diagnosis of lipoedema participated in a single semi-structured interview or focus group. These interviews/focus groups were transcribed verbatim, allowing for an inductive thematic analysis to be conducted.RESULTS: Sixteen participants were included and four main themes were identified. These included: the ongoing work of living with lipoedema, living with a restrictive and overwhelming condition, caught between self-acceptance and social judgement, and forced to navigate lipoedema alone. Across the four themes, 21 sub-themes emerged to convey the quality-of-life concerns experienced by individuals with lipoedema.CONCLUSIONS: Individuals living with lipoedema experience impacts on their quality-of-life across physical, psychological, and social aspects of life. This study highlights how the ongoing burden of physical symptoms, social perceptions, and healthcare-related challenges contributes to reduced quality-of-life for individuals living with lipoedema. Increased knowledge and awareness amongst healthcare providers is needed to improve care received by individuals living with this condition.PMID:42758894 | PMC:PMC13591986 | DOI:10.1080/17482631.2026.2734666

Front Med (Lausanne). 2026 Aug 31;13:1909592. doi: 10.3389/fmed.2026.1909592. eCollection 2026.ABSTRACTOBJECTIVE: Lipedema is a chronic adipose tissue disorder characterized by bilateral and symmetrical subcutaneous fat accumulation, predominantly affecting women. Because it is frequently confused with obesity and lymphedema, diagnosis may be delayed. This proof-of-concept study aimed to evaluate the feasibility of LipoAssist, a structured GPT-4-based clinical workflow designed for the preliminary assessment of lipedema under simulated conditions.METHODS: Ten simulated clinical scenarios representing lipedema and relevant differential diagnoses were evaluated using LipoAssist. The workflow was designed to obtain a structured medical history, assess clinically relevant symptoms, and generate a standardized case summary. Three board-certified Physical Medicine and Rehabilitation specialists independently evaluated the AI-generated outputs using a 5-point Likert scale across six criteria. A total of 180 ratings were analyzed. Inter-rater agreement was assessed using the intraclass correlation coefficient and Kendall’s coefficient of concordance.RESULTS: The overall mean performance score was 3.55 ± 0.64. The highest scores were observed for correct understanding of the clinical condition (4.63 ± 0.49) and identification of the most likely diagnosis (4.53 ± 0.51). Lower scores were recorded for recommendations regarding further diagnostic evaluation (2.17 ± 0.83) and assessment of surgical necessity (1.93 ± 0.64). Case-summary clarity and adequacy of history taking received mean scores of 3.87 ± 0.63 and 3.73 ± 0.64, respectively. Inter-rater agreement was good (ICC = 0.82; 95% CI: 0.68-0.91), and Kendall’s W was 0.79.CONCLUSION: LipoAssist demonstrated promising performance in structured history taking, organization of clinical information, and identification of the most likely diagnosis in simulated lipedema scenarios. However, its performance was limited in advanced diagnostic recommendations and surgical decision-making. These findings support the feasibility of a structured GPT-4-based workflow under simulated conditions but do not establish clinical validity, diagnostic accuracy, or readiness for routine implementation.PMID:42740861 | PMC:PMC13572100 | DOI:10.3389/fmed.2026.1909592

Pain Med. 2026 Sep 12:pnag120. doi: 10.1093/pm/pnag120. Online ahead of print.ABSTRACTOBJECTIVE: To comprehensively characterize pain in women with lipedema and evaluate its relationship with central sensitization, neuropathic pain characteristics, pain sensitivity, sleep quality, and quality of life.DESIGN: : A cross-sectional controlled study.SETTING: Department of Physical Medicine and Rehabilitation, Ankara Bilkent City Hospital.SUBJECTS: 59 women with Type 2-3, Stage 1-3 lipedema and 59 age-matched healthy controls.METHODS: Pain intensity, neuropathic pain characteristics, symptoms related to central sensitization, pain catastrophizing, sleep quality, health-related quality of life, and pressure pain thresholds were assessed using validated questionnaires and pressure algometry.RESULTS: Compared with healthy controls, women with lipedema had significantly higher pain intensity, painDETECT, Central Sensitization Inventory, pain catastrophizing, and sleep disturbance scores, whereas pressure pain thresholds and all Short Form-36 domain scores were significantly lower (all p < 0.001). Clinically significant symptoms related to central sensitization (Central Sensitization Inventory ≥40) were present in 78.0% of patients versus 8.5% of controls. These associations remained significant after adjustment for age and body mass index. Although pain intensity, painDETECT scores, and pressure pain thresholds were associated with disease stage, Central Sensitization Inventory scores were not.CONCLUSIONS: Pain in lipedema extends beyond local adipose tissue changes and is associated with widespread pain sensitivity, symptoms related to central sensitization, impaired sleep, pain catastrophizing, and reduced quality of life. These findings support a multidimensional approach to pain assessment in lipedema.PMID:42742114 | DOI:10.1093/pm/pnag120

Aesthetic Plast Surg. 2026 Sep 10. doi: 10.1007/s00266-026-06238-8. Online ahead of print.ABSTRACTBACKGROUND: Lipedema is a chronic adipose tissue disorder that may involve the upper extremities, particularly in advanced disease stages, leading to pain, heaviness, and functional complaints. While liposuction is an established treatment for symptom relief and volume reduction, its impact on objective upper-limb function-especially shoulder mobility-has not been systematically evaluated.METHODS: A prospective observational cohort study was conducted in female patients with upper-extremity lipedema undergoing circumferential arm liposuction. Active shoulder range of motion (ROM), including abduction, flexion, and external rotation, was assessed preoperatively and at 1, 3, 6, and 12 months postoperatively using standardized digital goniometry. Upper-limb disability (QuickDASH), pain, perceived heaviness, and upper-arm circumference were also recorded. Outcomes were analyzed over time and stratified by lipedema stage.RESULTS: Sixty-eight patients completed the 6-month primary follow-up. Mean active shoulder abduction improved significantly from 132.4° ± 13.8° at baseline to 154.7° ± 11.5° at 6 months and remained stable at 12 months (p < 0.001). Composite shoulder ROM demonstrated a similar progressive improvement. Patients with Stage II and III lipedema exhibited greater absolute functional gains, achieving postoperative ROM values comparable to those observed in earlier stages. QuickDASH scores, pain, and perceived heaviness decreased significantly over time (p < 0.001). Upper-arm circumference reduction correlated moderately with improvements in shoulder abduction (r = 0.42, p < 0.01). Measurement reliability was excellent (ICC ≥ 0.93).CONCLUSIONS: Upper-extremity liposuction for lipedema is associated with significant and durable improvements in shoulder mobility and upper-limb function. Beyond symptom relief and contour improvement, surgical debulking appears to restore functional movement, supporting the concept of upper-extremity lipedema as a functional disorder. Objective assessment of shoulder mobility should be considered an important outcome measure in the surgical evaluation of lipedema.LEVEL OF EVIDENCE IV: 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:42722924 | DOI:10.1007/s00266-026-06238-8

Health Care Women Int. 2026 Sep 8:1-15. doi: 10.1080/07399332.2026.2720245. Online ahead of print.ABSTRACTThis cross-sectional and descriptive study was conducted with 395 women to assess lipedema awareness, lipedema symptom levels, and the screening probability of lipedema. Data were collected using an Introduction Form, and the Questionnaire and Screening Model for Lipedema. The mean score on the lipedema screening questionnaire was 6.05 ± 4.58. It was determined that 15.4% of women had a high probability of developing lipedema. We found that participants demonstrated awareness regarding lipedema and that sociodemographic characteristics were associated with lipedema risk.PMID:42709932 | DOI:10.1080/07399332.2026.2720245

J Clin Imaging Sci. 2026 Aug 19;16:32. doi: 10.25259/JCIS_121_2026. eCollection 2026.ABSTRACTLower extremity swelling has a broad differential diagnosis, including lymphedema, obesity-induced lymphedema, phlebolymphedema, and lipedema. Although these conditions may appear similar clinically, their pathophysiology and lymphoscintigraphic findings differ. Obesity, venous insufficiency, and abnormal adipose tissue can complicate image interpretation. We present four representative cases to illustrate characteristic imaging patterns across these conditions. These cases highlight the importance of interpreting lymphoscintigraphy in a clinical context.PMID:42694790 | PMC:PMC13540783 | DOI:10.25259/JCIS_121_2026

J Clin Imaging Sci. 2026 Aug 19;16:32. doi: 10.25259/JCIS_121_2026. eCollection 2026.ABSTRACTLower extremity swelling has a broad differential diagnosis, including lymphedema, obesity-induced lymphedema, phlebolymphedema, and lipedema. Although these conditions may appear similar clinically, their pathophysiology and lymphoscintigraphic findings differ. Obesity, venous insufficiency, and abnormal adipose tissue can complicate image interpretation. We present four representative cases to illustrate characteristic imaging patterns across these conditions. These cases highlight the importance of interpreting lymphoscintigraphy in a clinical context.PMID:42694790 | PMC:PMC13540783 | DOI:10.25259/JCIS_121_2026

Lancet. 2026 Sep 5;408(10558):910-923. doi: 10.1016/S0140-6736(26)00910-4.ABSTRACTBACKGROUND: Lipoedema is a painful, chronic disease of the subcutaneous adipose tissue, predominantly affecting women. Conservative complex decongestive therapy is the standard of care but offers limited symptom relief. Liposuction appears to be a promising approach but lacks evidence of effectiveness and safety. The aim of this trial was to show superiority of liposuction compared with conservative therapy regarding relevant pain reduction with reasonable safety.METHODS: In this multicentre, randomised controlled trial at 11 German centres, eligible women with stage I, II, or III lipoedema and leg pain of at least 4 points on a 0-10 numeric rating scale received conservative therapy for up to 7 months and then were randomly assigned to liposuction or conservative therapy (2:1) stratified by lipoedema stage and study site. For all visits involving an assessment, patches were applied to the legs of all patients, and patients were instructed not to reveal the treatment they had received, in order to mask the assessor. The primary endpoint was reduction of patient-reported leg pain by at least 2 points after 12 months, and missing assessment was considered non-successful.The primary outcome was analysed in the intention-to-treat population which included all randomly assigned patients, and safety analysis included all enrolled patients. A long-term follow-up of 36 months is ongoing. This study is registered at ClinicalTrials.gov, NCT04272827.FINDINGS: Of 1973 patients screened between Jan 19, 2021, and June 7, 2022, 453 were enrolled, and 410 were randomly assigned to the liposuction group (n=278) or to the conservative therapy group (n=132). All 410 patients were included in the intention-to-treat analysis (mean age 42·9 [ SD 10·6]; ethnicity data were not collected). After 12 months, 190 (68%) of 278 randomisly assigned patients undergoing liposuction achieved the primary endpoint of pain reduction versus ten (8%) of 132 randomly assigned to conservative therapy (odds ratio 26·2 [95% CI 13·1-52·5]; p<0·0001). Adverse events occurred in 124 (47%) of 265 patients undergoing liposuction, and 20 (8%) of 265 were rated as serious. In the conservative therapy group, 30 (21%) of 145 patients reported adverse events, and five (3%) 145 were rated as serious. Secondary endpoints regarding quality of life showed greater improvement in the liposuction group.INTERPRETATION: Liposuction was superior to conservative therapy in reducing leg pain and improving quality of life in patients with lipoedema, but was associated with a higher rate of serious adverse events. Liposuction has the potential to be a promising treatment option for patients with lipoedema.FUNDING: The Federal Joint Committee, Germany.PMID:42692034 | DOI:10.1016/S0140-6736(26)00910-4

Lancet. 2026 Sep 5;408(10558):870-871. doi: 10.1016/S0140-6736(26)01328-0.NO ABSTRACTPMID:42692026 | DOI:10.1016/S0140-6736(26)01328-0

Lancet. 2026 Sep 5;408(10558):910-923. doi: 10.1016/S0140-6736(26)00910-4.ABSTRACTBACKGROUND: Lipoedema is a painful, chronic disease of the subcutaneous adipose tissue, predominantly affecting women. Conservative complex decongestive therapy is the standard of care but offers limited symptom relief. Liposuction appears to be a promising approach but lacks evidence of effectiveness and safety. The aim of this trial was to show superiority of liposuction compared with conservative therapy regarding relevant pain reduction with reasonable safety.METHODS: In this multicentre, randomised controlled trial at 11 German centres, eligible women with stage I, II, or III lipoedema and leg pain of at least 4 points on a 0-10 numeric rating scale received conservative therapy for up to 7 months and then were randomly assigned to liposuction or conservative therapy (2:1) stratified by lipoedema stage and study site. For all visits involving an assessment, patches were applied to the legs of all patients, and patients were instructed not to reveal the treatment they had received, in order to mask the assessor. The primary endpoint was reduction of patient-reported leg pain by at least 2 points after 12 months, and missing assessment was considered non-successful.The primary outcome was analysed in the intention-to-treat population which included all randomly assigned patients, and safety analysis included all enrolled patients. A long-term follow-up of 36 months is ongoing. This study is registered at ClinicalTrials.gov, NCT04272827.FINDINGS: Of 1973 patients screened between Jan 19, 2021, and June 7, 2022, 453 were enrolled, and 410 were randomly assigned to the liposuction group (n=278) or to the conservative therapy group (n=132). All 410 patients were included in the intention-to-treat analysis (mean age 42·9 [ SD 10·6]; ethnicity data were not collected). After 12 months, 190 (68%) of 278 randomisly assigned patients undergoing liposuction achieved the primary endpoint of pain reduction versus ten (8%) of 132 randomly assigned to conservative therapy (odds ratio 26·2 [95% CI 13·1-52·5]; p<0·0001). Adverse events occurred in 124 (47%) of 265 patients undergoing liposuction, and 20 (8%) of 265 were rated as serious. In the conservative therapy group, 30 (21%) of 145 patients reported adverse events, and five (3%) 145 were rated as serious. Secondary endpoints regarding quality of life showed greater improvement in the liposuction group.INTERPRETATION: Liposuction was superior to conservative therapy in reducing leg pain and improving quality of life in patients with lipoedema, but was associated with a higher rate of serious adverse events. Liposuction has the potential to be a promising treatment option for patients with lipoedema.FUNDING: The Federal Joint Committee, Germany.PMID:42692034 | DOI:10.1016/S0140-6736(26)00910-4

Obes Pillars. 2026 Aug 14;19:100316. doi: 10.1016/j.obpill.2026.100316. eCollection 2026 Sep.ABSTRACTBACKGROUND: Lipedema is a chronic medical condition primarily affecting women, characterized by bilateral, symmetrical, disproportionate fat deposition in the lower limbs, and sometimes arms and lower trunk. Pharmacological interventions remain limited, but glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual GLP-1/glucose-dependent insulinotropic polypeptide receptor agonists (GLP-1/GIP RAs) could provide potential therapeutic benefit due to their effects on weight, metabolism, pain, and inflammation.METHODS: This was a cross-sectional, patient-reported online survey study comparing self-reported lipedema symptom severity, medication use history, and physical and mental health outcomes across three groups of women with lipedema stratified by GLP-1/GIP receptor agonist medication use status (current users, discontinued users, and never-users). The survey captured demographics, lipedema characteristics, medication use history, and intensity of lipedema symptoms. Additionally, the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health-10 (PROMIS-10) instrument was used to assess physical and mental health. Analyses compared current users, discontinued users, and never-users of GLP-1/GIP RA medications.RESULTS: Of 2852 respondents, 2719 met inclusion criteria for analysis. Most participants (99.7%) identified as female, with a mean age of 52.4 years. Approximately 55% were current GLP-1/GIP RA users, most commonly taking tirzepatide. The primary reported reason for medication use was weight management (67.2%), followed by lipedema symptom management (19.3%). PROMIS-10 scores demonstrated higher physical and mental health ratings among current users compared with never-users (median Global Physical Health (GPH): 42.3 vs. 39.1; Global Mental Health (GMH): 44.9 vs. 40.8). Participants recalled improvements in both general health and lipedema symptoms after starting medication. Symptom severity scores for pain, swelling, and functional limitation were consistently lower among current users.CONCLUSIONS: Self-reported participant responses indicated improved health and symptom severity while using GLP-1/GIP RA medication. These findings support further investigation of GLP-1/GIP RA medications as potential therapeutic options for lipedema.PMID:42656629 | PMC:PMC13507742 | DOI:10.1016/j.obpill.2026.100316

Phlebology. 2026 Aug 23:2683555261480910. doi: 10.1177/02683555261480910. Online ahead of print.NO ABSTRACTPMID:42634465 | DOI:10.1177/02683555261480910

Phlebology. 2026 Aug 24:2683555261480911. doi: 10.1177/02683555261480911. Online ahead of print.NO ABSTRACTPMID:42637698 | DOI:10.1177/02683555261480911

Adipocyte. 2026 Dec;15(1):2719267. doi: 10.1080/21623945.2026.2719267. Epub 2026 Aug 20.ABSTRACTLipedema and obesity are chronic, frequently progressive disorders that can present with increased adipose-tissue volume, functional impairment and reduced quality of life. Although often approached as differential diagnoses, they frequently coexist and may aggravate one another. This narrative review addresses how lipedema and obesity interact biologically and clinically and what evidence supports a staged interdisciplinary approach to diagnosis and management. Obesity is increasingly conceptualized as an adiposity-based chronic disease characterized by excess adipose, abnormal adipose-tissue distribution or dysfunction, and associated medical or functional impairment. Obesity can impair lymphatic morphology and function, whereas lymphatic dysfunction may promote subcutaneous adipose-tissue expansion and fibrosis. Literature was identified through iterative PubMed searches and focused supplementary searches in Embase and the Cochrane Library. Publications were selected purposively for their relevance to predefined clinical and mechanistic domains; no systematic screening or formal risk-of-bias assessment was performed. This review synthesizes clinical overlap, biological evidence, diagnostic implications, and staged management for predominantly adult women with suspected or confirmed lipedema, including those with coexisting overweight or obesity. The proposed framework is intended to support clinical reasoning rather than serve as a formal guideline.PMID:42625406 | PMC:PMC13502036 | DOI:10.1080/21623945.2026.2719267

Tidsskr Nor Laegeforen. 2026 Jul 14;146(9). doi: 10.4045/tidsskr.25.0816. Print 2026 Aug 18.ABSTRACTBACKGROUND: Cashew nut allergy is increasing globally and may cause cross-allergic reactions to seed kernels from botanically related plants, including citrus.CASE PRESENTATION: A woman in her twenties with a known nut allergy developed anaphylaxis after consuming a sports drink containing citrus-derived pectin. Skin prick testing revealed reactions to the sports drink (6 mm), lemon seed (14 mm), citrus pectin (6 mm), cashew (16 mm) and pistachio (11 mm). Serum-specific IgE testing confirmed sensitisation to storage proteins in cashew and other nuts, including Ana o 3, Cor a 9, Cor a 14, Jug r 1 and Ara h 3. The patient tolerated citrus fruits but had experienced lipoedema on contact with sliced lemon seeds and mild reactions to factory-made jam. Avoidance of citrus seed kernels and added pectin was recommended.INTERPRETATION: This case illustrates a rare but clinically significant cross-allergy between cashew nuts, citrus seeds and citrus-derived pectin contaminated with citrus seed allergens. Clinicians should be aware of such cross-reactivity when evaluating unexplained severe allergic reactions in patients with cashew nut allergy.PMID:42622389 | DOI:10.4045/tidsskr.25.0816

Phlebology. 2026 Aug 18:2683555261478723. doi: 10.1177/02683555261478723. Online ahead of print.ABSTRACTObjectiveThis study aimed to investigate central sensitization (CS) in individuals with lipedema using pressure pain threshold measurements and to examine its relationship with clinical features, sonographic findings, body composition, and Central Sensitization Inventory (CSI) scores.MethodsA total of 61 female patients with lipedema and 20 healthy controls were included in this cross-sectional study. Pressure pain threshold (PPT) was assessed at the thigh, pretibial region, and forearm using a manual algometer. Sonographic subcutaneous fat thickness was evaluated, and body composition parameters were assessed using bioelectrical impedance analysis. Clinical outcomes related to CS-including the CSI, Visual Analog Scale (VAS), Lower Extremity Functional Scale (LEFS), Short Form-12 (SF-12), and the Extended Nordic Musculoskeletal Questionnaire (NMQ-E)-were recorded. Linear mixed-effects models were used to compare PPT across groups, anatomical sites, and disease stages. Associations between PPT, CSI scores, body composition parameters, sonographic findings, and clinical measures were evaluated using Pearson correlation analyses.ResultsPatients with lipedema exhibited significantly lower PPT values across all anatomical regions, including the forearm, and significantly higher CSI scores compared with healthy controls (p < .001). Sonographic assessment confirmed increased subcutaneous fat thickness in the lower extremities of lipedema patients. Lipedema stage was not associated with overall PPT levels. However, lower forearm PPT and LEFS scores were observed in more advanced stages. Forearm PPT showed significant negative correlations with lean body mass, body fat mass, and total body water (p < .05), while no other significant associations were identified.ConclusionIndividuals with lipedema demonstrate features consistent with CS, characterized by reduced PPTs in both affected and non-affected regions together with elevated CSI scores. These findings suggest that altered pain processing may contribute to the widespread pain and functional limitations observed in lipedema, highlighting the importance of comprehensive assessment of CS in this population.PMID:42613760 | DOI:10.1177/02683555261478723