Lymphedema, like varicose veins, is a progressive and often painless swelling of the legs that is caused by decreased transport capacity of the lymphatic vessels. There are two types of lymphedema , primary and secondary. Primary lymphedema is due to malfunction in the lymph conducting system. And secondary lymphedema is caused by acquired conditions such as filariasis, venous insufficiency, previous surgery, radiation therapy, malignancy, infection and inflammation.
|Latency||Risk for lymphedema, no |
|Stage I||Pitting, reduce over night|
|Stage II||No longer pitting, no full|
reduction with elevation
fibrosis and tender touch
|Stage III||Nonreversible, hardened fibrosis|
and sclerosis of subcutaneous
There are four stages from latency to stage III for lymphedema. At latency stage, although there is risk for lymthedema, no clinic change is noted. However at stage I, physical exam shows pitting edema. If not well controlled , it will progress to stages II and III, that include skin changes such as induration, hardening, fibrosis, tenderness, hyperkeratosis, warty projections, cobblestoning, and lichenification (see Fig).
The diagnosis of lymphedema includes several tests and thorough history and physical exams. As a part of the diagnostic procedure, systemic causes of edema should be ruled out. Furthermore, the evaluation should include assessment of the patient’s understanding of the disease process and commitment to the treatment regimen. The treatment for lymphedema is mainly physical treatment that includes exercise, compression stockings, manual lymphatic drainage, compression bandaging, pneumatic compression and elevation, etc. Other treatments , such as pharmacologic and surgical therapy, may benefit some patients.