# Effect of Compression Tights on Skin Temperature in Women with Lipedema
## 1 Introduction  
Lipedema is a chronic disorder of adipose tissue characterized by a symmetrical increase in limb size that affects mainly the female population and lower limbs [1; 2]. Moreover, lipedema causes pain, bruising, tenderness, and lower self-esteem due to aesthetic deformity, which reduces the quality of life [3; 4]. Lipedema is also associated with edema formation, which is related to a dysregulation of the veno-arterial reflex and capillary leak [1]. The lipedema diagnosis is complicated due to the lack of knowledge about its physiopathology and its similarity with other pathologies, such as obesity and lymphoma [1; 2], delaying this diagnosis and its specific treatment [1]. Lymphedema is produced by a dysfunction of the lymphatic system, which impairs lymphatic drainage, and it may be caused by a genetic origin or acquired from other diseases [5]. In this sense, lymphedema manifestations are asymmetrical with the absence of pain or bruising as opposed to lipedema, which is symmetrical on the limbs with the presence of pain and presents a chronic progression [6].  
Compressive therapy is part of lipedema conservative treatment that is effective in the reduction of pain, edema, and disorder progression [7; 8; 9]. The level of compression and type of knitting are the main aspects to keep in mind in garment development [10; 11]. The increased thickness of flat knitting tights allows the adjustment to big deformities, which is recommended for advanced lipedema [10; 11]. However, circular knitting tightsare seamless and more aesthetical due to the thinner material [12]. In addition, the use of the adequate size of compression tights is necessary to achieve good compression values and the beneficial effects of this treatment [7].  
It is recommended for people with lipedema to wear compression tights for many hours of the day to increase the beneficial effects of the treatment [7]. However, this long exposure could increase skin temperature due to the thermal insulation of the garment and sweat production [13; 14], reducing thermal comfort [13]. Infrared thermography is a non-invasive image technique that allows skin temperature assessment without contact [15; 16]. Although this tool has been employed in the assessment of different diseases such as breast cancer [17] or diabetic foot [18] and in the assessment of compressive garments [19], there is a lack of studies on lipedema assessment or the effect of compression garments in this population. However, the effect of compression garments on skin temperature has been previously studied in endurance athletes observing an increase after exercise [19] due to the thermal insulation properties of the compression garments [14], which increases skin temperature and can increase heat stress [19]. For this reason, it is interesting to assess the effect of compression garments in a population with lipedema after daily exercises, such as walking, to ensure that the garments used do not provoke high skin temperatures, which compromise optimal thermoregulation. Moreover, previous studies with other disorders, such as obesity or lymphedema, can provide some basis to expect results in the lipedema population because it has been shown that the percentage of adipose tissue reduces skin temperature [20]. In relation to lymphedema, regions with edema show higher skin temperature [21], and the skin temperature is elevated according to the severity of the lymphedema [22]. However, regions with tissue fibrosis obtain lower skin temperatures than those without skin pathologies [22].  
Therefore, the aims of the study were to analyze the effect of compression tights on skin temperature in women with lipedema and to assess the effect of circular and flat knitting prototype compression tights on skin temperature in women with lipedema. It was hypothesized that the use of compression tights would increase skin temperature at rest and after exercise. Furthermore, flat knitting tights could increase skin temperature more than circular knitting tights due to the higher thickness.