Lymphedema
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Lymphedema (Lat. lymphoedema) is a chronic condition resulting from impaired lymph outflow, i.e., the lymphatic fluid transported by the lymphatic system. As a result of lymph drainage disorders, protein-rich fluid accumulates in the tissues, leading to progressive swelling, fibrosis of the skin and subcutaneous tissue, and chronic inflammation. The disease can be primary — associated with developmental defects of lymphatic vessels — or secondary, resulting from, among others, surgical procedures, radiotherapy, injuries, infections, or chronic venous insufficiency. Lymphedema is not solely an aesthetic problem. Left untreated, it leads to deterioration of mobility, an increased risk of infection, and permanent skin and tissue changes.
Lymphedema - what it is and how it develops
The lymphatic system is responsible for draining excess interstitial fluid, transporting immune cells, and removing metabolic waste products from tissues. When its capacity is exceeded or damage to the lymphatic vessels occurs, lymph begins to accumulate in intercellular spaces. The result is the development of chronic edema.
The mechanism of lymphedema development involves several stages:
- lymph stasis in tissues,
- increased protein concentration in the interstitial space,
- activation of a chronic inflammatory process,
- tissue fibrosis,
- thickening of the skin and subcutaneous tissue.
Two main types of the condition are distinguished:
Primary lymphedema
It develops as a result of congenital abnormalities of the lymphatic system. It may manifest:
- in childhood,
- during puberty,
- in adults.
It most commonly affects the lower limbs and is progressive.
Secondary lymphedema
It is a significantly more common form of the disease. It develops as a result of:
- removal of lymph nodes,
- oncological radiotherapy,
- surgical trauma,
- chronic venous insufficiency,
- bacterial and parasitic infections,
- obesity,
- chronic inflammation.
A classic example is upper limb edema after breast cancer treatment with axillary lymphadenectomy.
Modern medicine treats lymphedema as a chronic disease requiring multidirectional therapeutic management and constant monitoring of the progression of changes.
Lymphedema - symptoms and location
Symptoms of lymphedema develop gradually. Initially, patients feel only a sensation of heaviness, skin tightness, or discomfort within the limb. In subsequent stages, a visible increase in tissue circumference occurs.
The most common symptoms include:
- chronic swelling of one or both limbs,
- a feeling of heaviness and tightness,
- restricted mobility,
- hardening and fibrosis of the skin,
- thickening of the subcutaneous tissue,
- recurrent skin inflammation,
- susceptibility to bacterial infections,
- positive Stemmer's sign (inability to pinch a fold of skin at the base of the fingers or toes).
In contrast to venous edema, lymphedema often also involves:
- the dorsum of the foot,
- toes,
- hand or fingers.
Most common locations:
- lower limbs,
- upper limbs,
- face area,
- genitals,
- postoperative area.
In advanced stages, the following may appear:
- papillomatous skin lesions,
- hyperkeratosis (excessive keratinization),
- lymph leakage through the skin,
- limb deformities referred to as elephantiasis.
A particularly significant clinical problem is recurrent bacterial erysipelas and cellulitis, which further damage the lymphatic system and exacerbate the course of the disease.
Lymphedema vs venous edema - the difference
Lymphedema and venous edema are sometimes confused with each other, but the mechanism of their formation, clinical picture, and treatment differ significantly.
Venous edema
It develops as a result of chronic venous insufficiency, i.e., impaired outflow of venous blood from the lower limbs. It is most commonly associated with:
- varicose veins,
- venous valve insufficiency,
- venous thrombosis.
Characteristic features:
- increased swelling at the end of the day,
- reduction after rest with legs elevated,
- presence of varicose veins,
- brownish skin discoloration,
- feeling of pressure and pain.
Lymphedema
It is a consequence of lymphatic system insufficiency and usually has a more chronic and progressive nature.
Typical features:
- swelling involving the toes and the dorsum of the foot,
- firm, fibrous consistency,
- less susceptibility to subsidence after rest,
- skin thickening,
- positive Stemmer's sign.
In clinical practice, mixed lymphatic-venous edemas also frequently occur. Long-standing venous insufficiency can lead to secondary damage to lymphatic vessels, which is referred to as phlebolymphoedema.
Proper diagnosis requires:
- clinical examination,
- Doppler ultrasonography,
- lymphoscintigraphy,
- sometimes magnetic resonance imaging or indocyanine lymphatic angiography.
Lymphedema - stages
The severity of lymphedema is most commonly assessed according to the classification of the International Society of Lymphology (ISL).
Stage 0 - latent phase
There is no visible swelling, but lymph transport is already impaired. The patient may experience:
- heaviness of the limb,
- skin tightness,
- discomfort.
This stage may persist for many months or years.
Stage III - lymphatic elephantiasis
The most advanced stage of the disease. The following occur:
- massive limb deformities,
- extensive fibrosis,
- hyperkeratosis,
- skin papillomatosis,
- chronic inflammatory conditions.
At this stage, the patient's physical function and quality of life deteriorate significantly.
The basis of lymphedema treatment remains complex decongestive therapy (Complex Decongestive Therapy – CDT), including:
- manual lymphatic drainage,
- compression therapy,
- movement therapy,
- skin care,
- infection prevention.
In selected cases, the following are also used:
- highly specialized physical therapy,
- lymphatic surgery procedures,
- microsurgical lymphatic-venous anastomoses,
- lymphedema liposuction.
Supportive therapy also utilizes modern procedures that improve microcirculation and reduce tissue congestion, including pressotherapy, medical compression therapy, and specialized decongestive physiotherapy treatments available in modern aesthetic medicine and phlebology centers.
