Lipoedema: The Unresolved Challenge of Delayed Diagnosis

For many patients, the journey to a lipoedema diagnosis is a long search for answers. Symptoms are often attributed to other conditions, body changes can be difficult to interpret, and years may pass without an accurate clinical assessment, turning a relatively common disease into one that remains widely underrecognised.

“Only 8% of patients come to their first consultation with an established diagnosis. This is an extremely important figure because it tells us that a huge number of patients either do not know they have this condition or spend years before discovering it “, explains Dr. Lorenzo Ricolfi, a physician and surgeon specializing in the diagnosis and treatment of lymphatic system disorders and lipoedema.

The absence of a diagnosis means living with an unrecognised disease, without an evaluation of possible associated comorbidities and without access to an appropriate treatment pathway. As a result, the disease may progress, and symptoms continue to have an increasingly significant impact on the patient’s daily life.

“Lipoedema is far more common than many people realize. The most recent statistics published by leading European vascular surgery and lymphology clinics indicate that between 11% and 17% of women are affected“, says Dr. Ricolfi.

Lipoedema Diagnosis: The First Step Toward Treatment

Because lipoedema can present differently from one individual to another, an accurate diagnosis cannot be limited to the assessment of a single body area. According to Dr. Ricolfi, the clinical examination must include a comprehensive evaluation of the patient.

“Fifty-four percent of patients experience involvement of both the lower and upper limbs, although it is common for signs and symptoms to appear asynchronously between them,” explains Dr. Ricolfi. “Many patients seek medical attention for what they perceive as the more obvious problem—for example, in the legs—while overlooking a milder but already existing condition in the arms, or vice versa.”

Diagnosis should also focus on the morphological characteristics of lipoedema, “that is, how adipose tissue is distributed in the affected body regions”; on identifying the lipoedema type, which “is unrelated to disease severity but instead represents an anatomical classification indicating where the condition is present”; and finally on staging, which refers to “the extent and severity of the disease.“

A comprehensive diagnosis should also include the assessment of specific diagnostic criteria, with particular attention to pain in the affected body regions, “whether spontaneous or elicited through specific clinical examination techniques. This allows the evaluation of so-called lipoalgia, the intrinsic pain originating from diseased adipose tissue.” Other overlapping clinical conditions, particularly those involving the lymphatic and vascular systems, should also be carefully assessed.

The Risks of a Superficial Lipoedema Diagnosis

While failing to diagnose lipoedema prevents patients from receiving appropriate care, an incomplete or rushed diagnosis can also have significant consequences.

“In addition to overlooking numerous factors that may influence the patient’s clinical condition, there is a risk of missing the broader picture of a disease that, according to the latest international consensus documents—including the Brazilian consensus published in 2025—is defined as both a chronic and, above all, a systemic disease.“

One important aspect is the presence of comorbidities, whose development “is not directly proportional to the peripheral extent of the disease. This means that some patients may have advanced-stage lipoedema, with considerable tissue volume and significant symptoms, yet few or no comorbidities. Conversely, young patients with only subtle signs of lipoedema may already present with clinically significant comorbidities.”

Assessing comorbidities allows for a comprehensive and personalised treatment approach aimed at protecting the patient’s overall health over the long term.

“Diagnosis is clinical and must be made by a physician.”

The Most Common Misdiagnoses

One of the greatest challenges in diagnosing lipoedema is that it is often mistaken for other conditions with apparently similar characteristics. According to Dr. Ricolfi, the most common historical misconception has been confusing lipoedema with obesity. In recent years, however, another diagnostic error has become increasingly frequent: misdiagnosis as lymphedema.

“We must continue to raise awareness and educate healthcare professionals about the importance of correctly differentiating lipoedema from other conditions that may mimic it or share some of its clinical features.“

Lymphedema and lipoedema are fundamentally different diseases. Lymphedema is “a disorder of the lymphatic system characterized by impaired or blocked lymphatic circulation, resulting in the accumulation of lymphatic fluid in peripheral tissues.”

Lipoedema, by contrast, is “a genetically based disease of adipose tissue that predominantly affects women. According to our published research, approximately 80% of patients have a first- or second-degree relative with the condition. Lipoedema is also characterized by an increased tendency to develop bruising. It is typically painful, develops bilaterally and symmetrically, spares the hands and feet, and may affect multiple body regions simultaneously.“

According to Dr. Ricolfi, “it is essential that clinicians possess at least the basic semiological knowledge needed to establish an accurate diagnosis and perform an appropriate differential diagnosis among conditions that can already be distinguished clinically. I emphasise clinically because even lymphedema can generally be diagnosed through clinical evaluation alone, without necessarily requiring instrumental examinations.“

Treating the Patient as a Whole

If asked to offer just one practical recommendation to clinicians, Dr. Ricolfi has no hesitation:

“Maintain a multidisciplinary and multimodal therapeutic approach in the management of patients with lipoedema, while embracing the concept of the complex patient. The term ‘complex’ should not simply imply greater difficulty in management but should reflect the principles of complex care, where the patient is viewed as having a multifaceted disease whose various aspects interact and influence one another to varying degrees.“

This calls for a shift in perspective in patient management, with the goal of broadening the clinical approach to a chronic disease. It means developing the most coordinated care pathway possible, focused primarily on reducing signs and symptoms and achieving long-term disease stabilization through an appropriate therapeutic plan and a personalized treatment algorithm.