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Joachim Zuther, Lymphedema Specialist. Read more
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Differences between Lipedema and Lymphedema


As outlined in a  previous entry, lipedema is a chronically progressive, symmetrical accumulation of fat in the subcutaneous tissue occurring almost exclusively in women. Primarily the lower extremities are affected, but lipedema may occur in combination with the upper extremities as well. Lipedema is characterized by symmetric enlargement of the limbs, combined with tenderness and easy bruising.

Lipedema is not caused by a disorder of the lymphatic system; however, it is commonly misdiagnosed as bilateral primary lymphedema.

Several marked differences between lipedema and primary lymphedema can be distinguished; these differences are highlighted in the table below.


While lipedema always affects both legs symmetrically (bilateral appearance), primary lymphedema usually affects one leg only. If both legs are involved in primary lymphedema the swelling appears asymmetric (see image on bottom of this article). The feet are not involved in lipedema; the symmetrical distribution of fat is located between the hips and the ankles.
In contrast, the feet in lymphedema are involved in the swelling, and a diagnostic indicator known as the Stemmer sign is positive.
The Stemmer sign is a diagnostic test that involves pinching the skin on the upper surface of the toe (usually second toe) or fingers. If a fold of skin can be pinched and lifted up at the base of the second toe or middle finger, the Stemmer sign is negative. The Stemmer sign is positive and indicative of lymphedema when a skin fold cannot be lifted, but can only be grasped as a lump of tissue. This sign  will become positive if lipedema develops into lipo-lymphedema. Circumstances that can lead to lipedema developing into lymphedema are explained in a previous post.
Tissue in lipedema has a soft rubber-like feel in early stages and may include small fatty lumps (nodules) within the tissues in

Fatty nodules in lipedema

later stages. Pressure with the thumb does not leave an indentation (no pitting) in lipedema. Lymphedema is pitting and the tissue feels firmer that the one in lipedema, especially with fibrotic tissue typically being present starting in stage 2. The cause for the onset of lymphedema are malformations of the lymphatic system, while he underlying cause for the development of lipedema remains unknown; it is thought to be associated with hormonal disorders.



Differences at a Glance


Lipedema Lymphedema
Symmetric (buttocks involved) Not symmetric
Foot not involved Foot involved
Not pitting Pitting edema
Stemmer sign negative Stemmer sign positive
Tissue feels rubbery Tissue feels firmer (starting stage 2 lymphedema)
Painful to touch Generally not painful to touch
Easy bruising Generally not bruising
Hormonal disturbances frequent Generally no hormonal disturbance

Stemmer sign; positive on left

Primary bilateral lymphedema

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28 comments to Differences between Lipedema and Lymphedema

  • Pat

    Another great page of info. Thanks!!!! To treat correctly it is critical to understand the two conditions, how they are and/or are not related. It is also terribly important for those with lipedema to understand this is NOT a weight issue in the sense that you can NOT diet your way out of lipedema. The Lymphedema Blog is definitely on my list of favorite sites both in terms of topics, your willingness to reach out to patients and then in the use of evidence based medicine.

  • Mary Beth

    There is also an extremely rare condition called Dercum’s Disease which presents with extremely painful fatty nodules and can include swelling. Some of these patients have been misdiagnosed as lipedema or lipolymphedema. I have treated one patient with it who found relief with MLD (although initially with nausea) and has found even greater relief with daily use of Flexitouch.

  • Is there any cure or treatment for lypedema?

  • Joey Beth

    I have Lymphedema and my left leg is extremely sensitive…if I barely bump it the pain is excruciating.

  • debbie west

    I KNOW it is Hormonally related. When I was 32 years old, I had to have hysterctomy for endometriosis. After they took everything, I noticed that I started distributing fat in a different way! I was about 130lbs, and 5’7” …..but I noticed on my thighs, I was starting to get little round globulas underneath the skin of small circles of fat. It seemed as though it was no longer being evenly distributed. I tried to tell my Dr’s but just didn’t know, or didn’t take the time to figure it out, or thought I was over`reating. Now I am a few years away from 60. I developed Lymphedema in my right arm, no breast surgery. The round areas of fat have gotten much worse. I am on NO hormone replacement for 6 years now because I have had 3 PE’s (blood clots in the lungs)….so they will give me no hormones. I’m telling you, it’s time for the Medical World to wake up and realize that Hormones do a LOT more for us than what we know, or have studied!! Since I have been without hormones, I am getting facial changes. That feminine look is going away, I’m getting chin hair, you know the whole bunch of changes. I believe that women aged and died younger years ago, due to loss of hormones partly. Then they had to figure out what kind and how much to replace. This has a BIG difference in the aging process, I am convinced!! I need to find a natural replacement that will at least help restore something, though I fear it may already be too late. Did I mention it is almost near impossible to loose weight? Don’t eat, you don’t loose. Eat a little you balloon up….!!! Arrrggggg!!!!!

  • Pamela Hain

    I have edema in both legs and both hands.I believe it is lymphedema. The therapist says that it is not possible to have lymphedema in all four extremities. She also says lymphedema does not cause pain. I had breast cancer surgery 7 years ago and 27 lymph nodes were removed and was followed by radiation.

  • Regina

    Has anyone with Lympoedema and lipedema ever received disability benefits either from work or the state that they live in. Are they starting to take it as a serious disease. Any help in this area would be greatly appreciated,

    • Alicia

      Hello Regina yes I do receive disability for lymphedema from the state.

      • Cheri

        Alicia, If it is acceptable, I would like to discuss the disability benefits for Lymphedema. I have bilateral lower extremity lymphedema and I use the flexitouch system daily. I work at a desk and by the end of the day my legs are extremely swollen and painful even though I try to elevate them at my desk and I wear “Ready wraps”.

  • Roberta

    are there any MD/PHD lympoedema/Lympedema etc docs/ researchers in Boston area or on East Coast?

    • Joachim Zuther

      Dear Roberta:

      Below is a link, which lists MD’s specialized in lymphedema treatment.

      You may also contact the National Lymphedema Network (NLN) or click on the “Find a Therapist” link on top of this page in order to locate a therapist in your area. Therapists are usually familiar with local physicians specializing in this condition.

      Hope this helped,

  • Tanya

    I have lipedema. Both of my legs are affected, as my feet are not. My mother has primary lymphedema. Usually, docs diagnosis me with lymphedema, however, fluid pills usually help with the swelling that does occur in my legs due to the excessive weight I carry. While I do not look obese, I am and have always struggled with my weight…however, I am heaviest on my lower extremities. I can lose weight in my upper body, but never seem to do much to my lower body. Very frustrating. Any treatment or suggestions out there on how to manage lipedema best? I have a somewhat active lifestyle, I eat well, very healthy, see a nutritionist biweekly, but the weight just never comes off. I am only 38 and I hate my body, always have since I was 12 or 13. Any help would be great!

  • Joy

    …I was recently diagnosed by an Endocrinologist as having Lipedema. I just started seeing a Massage Therapist, and she thinks it’s Lymphedema.

    The symptoms are a little of both. I have no feet swelling, but I have no leg sensitivity, as she can massage them without issue. My right leg is slightly larger than my left, but I have swelling in both. I bruise very easily below the knees. I lose weight off the top half of my body easily, but barely any off the bottom.

    Is it possible to have LIPEDEMA WITHOUT leg sensitivity, or is it possible to have LYMPHEDEMA WITHOUT feet swelling?

    It’s very confusing.

    • Joachim Zuther

      Joy, without knowing you personally, I am unable to say if you are affected by lipedema or lymphedema. There is also a combination of both, which is known as lipo-lymphedema. While lymphedema generally affects the feet as well, there are cases where the feet are not swollen. Should the circumference of your legs decrease with appropriate therapy (I hope your therapist is certified in lymphedema management), then you most likely have lymphedema.
      Hope this helped.

  • Adria R.

    I believe that I may possibly have lipedema. I’ve always had “tree trunk” -like legs but after having my son (fourth pregnancy but first live birth) in 2010, I gained 80 pounds from the pregnancy and nothing has been the same since. Terrible cellulite but unlike the other cellulite I see on girlfriends. Pain, though only mild to moderate at times, is mainly in my left leg starting behind my knee going down through my calf. My left calf is larger than my right by about an inch and it has left the doctors mystified. I’ve had ultrasounds done to check for DVT but they are all normal. I am size XS to S on the upper half of my body and I am a L-XL (8 on a good day but normally 10-12) on the lower half.

    This has caused me terrible issues, especially self-esteem problems, and I have yet to find a doctor that is willing to go further after an ultrasound. What type of doctor should I be seeing for this issue? Thank you!

  • Laura

    I have just went for a massage whilst on holiday and been told I have lymphedena, I’ve always had massive legs and thighs (size 18 thighs and size 10 top half) I’ve always just thought I was just fat even though I exercise regularly and eat well and I only drink water I have most of the sypmtoms of lipedema since my legs r both the same and my feet are fine, but I’m getting paranoid now and not sure what to do to digagnoise it or treat it? I’m based in the UK and advice is welcomed?!
    I’m worried the massage guy is trying to scam me to buy more massages he said I need three to drain this week?!

  • Janice Monfre

    about 10 years ago i was diagnosed with Lymphedema . All of a sudden my legs will break out in a horrible rash on the lower part of my leg. that causes me to have them wrapped for sometimes weeks on end. But my legs hurt all the time.It pains me to put my stockings on.. My left leg is much bigger then my right. My feet are always swollen as are my legs. It is just really frustrating to have to go through this.

  • Kathy Suarez

    I have Dercum’s Disease and nothing the Dr’s here in KY are helping they have me on Lyrica Ketoprofen Aspirin Alpha Lipoic Acid and Pain Medicine but nothing is helping and it seems like none of them are interested in looking information up on it. I have taken print out from Dr Karen Herbst web site with information on how to help and to no avail. Today I went to Pain Management and was told they don’t know why I was sent there they can’t do anything to help. I am so frusterated please help if anyone can. Thanks in advance

  • Sheri

    I am 39 years old. I have lived with chronic pain, fatigue, headaches, etc for past 10 years. Things progressed during my pregnancies (2006 & 2009). During my second pregnancy I developed an area of swelling on the medial side of my left ankle. Both legs are swollen (left more than right) but not my feet. Now my legs are extremely painful if touched or bumped by anything and i have become very guarded. I saw a physiatrist 9 months ago who diagnosed me with fibromyalgia. He told me the left ankle was “adipose tissue”. Do you think this may be lipedema? I am desperate to follow up on this as my pain is increasing and I am struggling to get through my work days as I am a rehab therapist and on my feet all day. I would appreciate any suggestions. thank you!

  • Dora Bustamante

    hi, I was told I have lymphedema about three months ago, is there any doctors that do lipo for lymphedema in San Antiono I can’t find a doctor hear. Can some help me?

    • Joachim Zuther

      I would suggest you contact the National Lymphedema Network (NLN) in San Francisco – they will be able to assist you

  • Maggie

    I’m sorry you are going through the Dercum’s pain with no help. I just saw Dr. Herbst and was diagnosed with Dercum’s, lipoedema, and lymphadema. She did say for us Dercum’s patients the RAD or south beach diet really helps. I’ll tell you I did the RAD DIET before and lost 40lbs in a month…starting weight 220lbs. It did give me a lot more energy but it then made my lumps much more prominent and painful…even to sit (they’re everywhere) so I figured I’d rather less pain, less energy because it’s very, very hard to get pain control as it is. The Dr said that, that will happen but