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Krankheiten Wissenschaft

Lipödem- Eine unterschätzte Volkskrankheit?

Das Lipödem – eine Krankheit unter der sehr viele Frauen leiden.
Der Leidensdruck ist hoch. Abwertende Blicke häufig. Die Krankheit zu selten richtig diagnostiziert.
Wir möchten auch hier wieder „Licht ins Dunkle“ bringen und haben eine Expertin zu Gast:
Dr. med. Anna Theresa Bauer, Ärztin in der Plastischen Chirurgie am Klinik Rechts der Isar München und Expertin für Lipödem beantwortet  einen Teil der häufigsten Fragen.

Wie häufig kommt das Lipödem vor?

Fast 10% der Frauen in Deutschland haben ein Lipödem, trotzdem erhalten rund 70% dieser Patientinnen keine adäquate Diagnostik und wissen teilweise noch nicht einmal, dass sie krank sind.
Der Grund dafür ist die weit verbreitete Unkenntnis von Ärzten und Therapeuten, die ein Lipödem nicht richtig diagnostizieren und mit Venenleiden oder Adipositas verwechseln.

Was ist die Ursache des Lipödem?

Die Ursache des Lipödems ist bisher unbekannt. Eine genetische Komponente wird aufgrund von positiven Familienanamnesen bei vielen betroffenen Familienmitgliedern angenommen.
Ebenfalls wird eine hormonelle Komponente aufgrund der fast ausschließlich weiblichen Patientinnen vermutet und  mit einem Ausbruch bzw Fortschreiten der Krankheit in den Phasen des hormonellen Umschwungs (Pubertät, Schwangerschaft, Pille, Menopause) in Verbindung gebracht.
Charakteristisch ist, dass sich die erkrankten Fettzellen nicht durch Sport oder Ernährungsmaßnahmen beeinflussen lassen.
Eine fehlende Transportfähigkeit der Lymphgefäße führt sekundär zu einem Stau an lipid-und proteinreichen Substanzen rund um die Fettzellen. Da der Abtransport nicht gewährleistet ist kommt es zu einer vermehrten Ansammlung ebenfalls in den Fettzellen.
Sekundär entwickeln sich in höheren Stadien ein chronisches Lymphödem und eine Verhärtung der Fettzellen.
Wenn das Lipödem nicht behandelt wird, tritt der Zustand des therapieresistenten chronischen Lipolymphödems nach ca 15-20 Jahren ein.  Die charakteristische Fettverteilungsstörung zeigt sich vor allem an den Extremitäten.
Typisch ist auch, dass Hände und Füße schlank sind (negatives Stemmer Zeichen), im Gegensatz zum Lymphödem (positives Stemmer Zeichen). Dies kann man selbst einfach testen, indem man versucht eine Falte zu bilden mit den Fingern an dem 2.Zeh. Wenn es nicht möglich ist, liegt wahrscheinlich kein Lipödem, sondern ein Lymphödem oder eine Mischform vor.

Aufgrund des säulenförmigen Aussehens der Beine und der verstrichenen Konturen über den Gelenken wurde es im Volksmund auch häufig als sogenanntes „Säulenbein“ bezeichnet.
Weiter kennzeichnend für ein Lipödem ist die Gefäßfragilität, die sich durch ein leichtes Auftreten von Hämatomen bei inadäquatem Druck oder Berührung der Extremitäten ergeben.
Desweiteren klagen die Patientinnen meist über Ruheschmerzen in den Beinen, vor allem nach längerer Belastung. Die ästhetische Beeinträchtigung aufgrund der Cellulite („Matratzenphänomen“) führt aufgrund der teils massiven Einschränkung im Alltag und durch eine fehlende Kenntnis dieser Erkrankung in der Gesellschaft häufig zu depressiven Erkrankungen.

Wie kann man das Lipödem einteilen?

Die Einteilung erfolgt nach Morphologie in mehreren Stadien.

  • Stadium 1 ist gekennzeichnet durch eine glat
  • te Hautoberfläche mit gleichmäßig verdickter, homogen imponierender Subkutis.
  • In Stadium 2 zeigt sich eine uneben, überwiegend wellenartige Hautoberfläche, knotenartige Strukturen im verdickten Subkutanbereich.
  • In Stadium 3 zeigt sich eine ausgeprägte Umfangsvermehrung mit überhängenden Gewebeanteilen (Wammenbildung) an Armen und Beinen.


Des Weiteren unterscheidet man (nach Herpertz) in 6 verschiedene Typen:

  • Oberschenkel-Typ
  • Unterschenkeltyp
  • Ganzbeintyp
  • Oberarmtyp
  • Unterarmtyp
  • Ganzarmtyp

Das Lipödem kann sich auf den gesamten Körper ausbreiten und an jeder der Extremitäten manifestieren.
Die wichtigste Differenzialdiagnose ist dabei die Adipositas, weshalb der BMI bei der Diagnostik ein wichtiges Kriterium spielt. Selbstverständlich treten auch im weiteren Verlauf Mischformen von Lipödem, Lymphödem und Adipositas auf.
Das wohl wichtigste Unterscheidungskriterium zur Adipositas ist die Schmerzhaftigkeit dieser Krankheit. Es ist nicht einfach nur ein ästhetisches Problem unter dem die Betroffenen leiden, sondern bereitet vor allem mit sommerlichen Temperaturen zunehmend Schmerzen und Spannungsgefühle.

Wo kann ich mich weiter informieren?

Wollt ihr mehr erfahren? Am Klinikum Rechts der Isar findet am 26.05.2018 zu den Themen Lipödem/Lymphödem ein kostenloser Informationstag statt bei dem auch auf die Möglichkeiten der Kostenübernahme durch Krankenkassen, rechtliche Einspruchsmöglichkeiten und Therapiemaßahmen, sowie auf aktuelle Forschung hingewiesen wird.
Bei Interesse könnt ihr euch gerne an Anna-Theresa Bauer wenden.
email: anna-theresa.bauer@mri.tum.de
.. Teil 2 über die Behandlung des Lipödems folgt in den kommenden Tagen!
Dieser Artikel ist ein Gastarztbeitrag von Dr.med. Bauer. Wie bei all unseren Gastarztbeiträgen übernehmen wir für die Inhalte kein Gewähr. 
Titelbild: medi.de
 
 

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