Abstract
Lipoedema is a chronic, progressive, and painful disorder characterised by symmetrical accumulation of subcutaneous adipose tissue in the limbs, with typical sparing of the hands and feet, and a marked predominance in females. Onset most frequently occurs during hormonal transitions such as puberty, pregnancy, and menopause, and may be associated with a hereditary predisposition. The pathophysiology involves the interaction of genetic and hormonal factors, in association with microvascular and lymphatic dysfunction, adipocyte hyperplasia and hypertrophy, and chronic inflammatory processes. The clinical picture includes spontaneous or pressure-induced pain, hypersensitivity, easy bruising, and functional limitations, with a significant psychosocial impact. Diagnosis is clinical, based on positive criteria and the exclusion of conditions with similar presentations such as obesity, lymphoedema, lipo-hypertrophy, and Dercum’s disease. Management is primarily conservative and includes regular physical exercise, compression therapy, and complex decongestive lymphatic therapy. In refractory cases, liposuction is a surgical option with low risk and excellent outcomes. Poor awareness of the condition and the absence of specific biomarkers contribute to substantial underdiagnosis. Early recognition by general practitioners is crucial for timely referral to an angiologist, who serves as a reference figure for excluding vascular comorbidities and defining a multidisciplinary diagnostic and therapeutic pathway involving nutritionists, psychologists, and physiotherapists, with the aim of preventing disease progression and improving quality of life.