Lymphedema

Key Points
Skin condition which may affect the face, groin, or extremities
Caused by impairment of the lymphatic system
Consists of swelling in the affected area, which may be accompanied by various symptoms

Lymphedema is a skin condition which affects the lymphatic system, and typically presents in the legs, arms, face, or groin. The condition consists of swelling in the affected area, which is slight in the initial stages of the condition. This swelling may be accompanied by a change in sensation or temperature in the affected area, joint pain, tenderness, impaired mobility, and heaviness/tightness. In cases which are left untreated, swelling can become permanent. Additionally, lack of treatment may lead to changes in the skin, including thickening, warty, dry patches, bulges, and an increased risk of secondary skin infection. Lymphoedema affecting the legs is typically more damaging, as treatment is more difficult.

There are two sub-types of lymphoedema, primary and secondary. In primary lymphoedema, lymphatic system impairment which causes the condition is typically congenital, and symptoms usually appear by age 35. Primary lymphoedema is more common in females, but may occur in males as well. Secondary lymphoedema develops in relation to an underlying condition which has affected the lymphatic system, such as direct damage via injury or infection, chronic venous conditions, lymph node removal surgery (used in treatment of some cancers), radiotherapy, and limited mobility.

Lymphoedema develops when the lymphatic system is in some way damaged, resulting in a buildup of fluid which is normally processed through the lymphatic system and sent back into the bloodstream. The buildup of lymph fluid results in swelling.

Differential Diagnosis (Other conditions with similar appearance)
Cellulitis
Lymphangioma
Dermatologic Manifestations of Cardiac Disease
Pretibial Myxedema
Dermatologic Manifestations of Renal Disease
Thrombophlebitis
Erysipelas
Venous Insufficiency
Filariasis

Diagnosis
Key Points
Diagnosis based on appearance of the affected area in conjunction with medical history
Special radiographic tests may be performed to confirm diagnosis and determine the extent of the disorder
Cancer screening may be recommended

Lymphoedema is typically diagnosed based on the appearance of the affected area in conjunction with a clinical examination of the affected person's medical history. A special radiographic test, lymphoscintigraphy, may be performed to confirm the diagnosis and to determine the extent of the condition. Additionally, cancer screening may be recommended to rule out other conditions.

Treatment
Condition is chronic and persistent, with no cure
Goal of treatment is reduction and control of swelling
*Specific treatment regimens are required, even in mild cases

Lymphoedema is a chronic and persistent condition, and there is no cure. The goal of treatment is to reduce and control swelling in the affected areas. In moderate cases, a treatment regimen known as Complex Physical Therapy (CPT) is often used. This therapy consists of proper skin care (reducing chance of infection, maintain skin moisture, remove dead or hardened skin), drainage of the lymph glands through massage, compression bandaging of the affected area, and specifically designed exercise programs. Severe cases may require other treatments, in conjunction with CPT, including manual lymphatic drainage (physical therapy technique which drains the lymphatic system), multi-layer compression bandaging, and in rare cases, surgical drainage of the lymphatic system.