Clinically Diagnosing, Managing & Treating Lipedema In Singapore

Key takeaways

• No specific scan or blood test diagnoses lipedema; diagnosis is clinical.
• Key signs: pain or tenderness, easy bruising, negative Stemmer’s sign, edema and psychological impact ^{[4, 5, 6, 7, 8, 9, 10, 11, 12]}.
• A negative Stemmer’s sign points to lipedema; a positive sign may indicate co-existing lymphedema.
• Imaging (ultrasound or MRI) is used to rule out similar conditions, not to confirm lipedema.
• Self-checks and the “pinch test” raise awareness but are not diagnostic.
• It may be more common in Asian women, including in Singapore, than previously understood ^{[2, 3]}.

What is lipedema?

Lipedema is a chronic medical condition estimated to affect about 11% of adult women worldwide ^[1]. It is characterised by a symmetrical buildup of painful, disproportionate fat, typically in the legs and arms. It is more than a cosmetic concern: it affects mobility and quality of life.

It is also known as lipoedema, adiposis dolorosa or painful fat.

Is lipedema becoming more recognised in Singapore?

Yes. Lipedema has historically been under-recognised in Asian populations, which has made prevalence studies difficult. Recent clinical publications and case studies show a growing focus on lipedema in Asia ^{[2, 3]}. This suggests it may be more common among Asian women, including in Singapore, than previously understood.

Amaris B. Clinic has seen a significant and rising number of patients consulting medical director Dr Ivan Puah for lipedema assessment and management.

Worldwide diagnostic criteria for lipedema (Lipedema Foundation)

The Lipedema Foundation reviewed 9 published diagnostic criteria from 1940 to 2021. The symptoms studied were:

The 5 symptoms all 9 studies agreed on ^{[4, 5, 6, 7, 8, 9, 10, 11, 12]}

1. Pain or tenderness to touch: Discomfort or pain in the affected fat is a frequent hallmark.
2. Easy bruising: Patients often bruise easily in the affected areas.
3. Negative Stemmer’s sign: Pinching a skin fold at the base of the second toe or finger helps tell lipedema from lymphedema.
4. Edema (pitting or non-pitting): Mild swelling may appear, especially as the day goes on.
5. Psychological involvement: The chronic nature of lipedema often affects self-esteem and mental wellbeing.

How is lipedema diagnosed in Singapore?

At Amaris B. Clinic, diagnosis uses four steps:

1. Visual inspection: The doctor looks for symmetrical fat enlargement in the limbs, a disproportionate body shape (for example, a smaller upper body than lower body) and skin changes such as coolness or visible telangiectasia (spider veins).
2. Palpation: Affected tissue may feel soft and nodular (like peas or rice under the skin) or firm and fibrotic, and is often tender.
3. Stemmer sign test: A key differential tool. If you can pinch the skin (negative sign), it suggests lipedema. A positive sign may indicate co-existing lymphedema.
4. Detailed medical history: Personal and family history, symptom onset (often around puberty, pregnancy or other hormonal shifts), mobility issues, response to diet and exercise, and the impact on daily life.

Do I need a scan or blood test to diagnose lipedema?

No. Currently no specific scan or blood test diagnoses lipedema.

• Blood tests are typically done before any surgery to ensure patient safety.
• Imaging (ultrasound or MRI) may be used selectively to rule out conditions with similar presentations, such as lymphedema, chronic venous disease or lipohypertrophy.

If you suspect lipedema, book a consultation with Dr Ivan Puah for a clinical assessment and a tailored management plan.

FAQ

How is lipedema diagnosed?

Clinically, through a detailed history and physical examination (visual inspection, palpation and the Stemmer sign test). No single scan or blood test confirms it.

Can I self-diagnose lipedema?

No. Online checklists and the “pinch test” can raise awareness but are not diagnostic tools. Lipedema shares symptoms with other conditions, so a definitive diagnosis needs a clinical assessment by an experienced doctor.

Can lipedema be misdiagnosed?

Yes. It is often mistaken for simple obesity or lymphedema, or dismissed entirely. See a doctor knowledgeable about the condition for an accurate diagnosis and appropriate care plan.

How common is lipedema?

It is estimated to affect about 11% of adult women worldwide ^[1]. It is thought to be under-recognised in Asian populations ^{[2, 3]}.

What is the difference between lipedema and lymphedema?

The Stemmer sign helps tell them apart. A negative sign suggests lipedema; a positive sign may indicate lymphedema, which can co-exist.

Do I need to bring a support person to my consultation?

It can help. Lipedema is painful and affects confidence and mobility, so a friend or family member can give moral support and help you remember what was discussed.

What questions should I ask my lipedema doctor?

A good doctor answers patiently, clearly and transparently. Ask:

• What stage or type of lipedema do I have?
• Am I a suitable candidate for surgery, and what are the realistic long-term outcomes?
• What is your specific experience in treating lipedema?
• What does recovery involve?
• What are the costs, and is the procedure eligible for MediSave claims?

What red flags should I watch for in a consultation?

Be cautious of any practitioner who says “lipedema is just obesity,” recommends only weight loss as the cure, or calls it a social media trend or internet disease. A qualified doctor takes your symptoms seriously and gives a comprehensive assessment and tailored management options.