Lymphatic oedema – causes, symptoms and treatment
Lymphatic oedema or lymphoedema is a swelling of tissues caused by non-physiological fluid retension (lymph). As a result of improper functioning of the lymphatic system in the skin and subcutaneous tissue too much extracellular fluid is accumulated, which leads to limb swelling, skin lesions, fibrosis, inflammations or elephantiasis.
Lymphoedema may be either primary, which can occur as a result of congenital defects or secondary, which is most often the result of damage to lymphatic vessels, e.g. due to injury. This is a serious condition which can even result in amputation of the limbs.
Primary lymphodema (congenital) is a disorder that usually occurs as a result of abnormal development of capillaries such as:
- aplasia (absence of capillaries),
- small number of capillaries,
- underdevelopment or incomplete development of capillaries (e.g. hypoplasia).
Congenital lymphoedema may also be caused by the hereditary Milroy’s disease, the condition which disrupts the process of vascular endothelium growth.
Secondary lymphodema results from damage to the lymphatic vessels. It can occur, among others, as a result of:
- mechanical injury (dislocation, fractures),
- enhanced tumor growth, which puts pressure on lymphatic vessels or lymph nodes,
- inflammation (e.g. skin, lymph nodes or lymphatic vessels),
- surgery (e.g. lymph nodes removal),
- surgical treatment of tumors (eg removal of reproductive organs or breasts),
- postoperative complications,
- cancer therapy, radiation therapy,
- chronic venous insufficiency,
- connective tissue diseases (rheumatoid arthritis, psoriatic arthritis, systemic sclerosis),
- bacterial infection (e.g. streptococcus),
- parasites (eg nematodes which evoke elephantiasis).
The lymph function is to eliminate unnecessary substances from the tissues. Impaired functioning of the lymphatic vessels causes the substances to remain in the tissues. At the initial stage of the disease the body tries to cope with the problem of increased lymph production and the stage is referred to as the latent stage. Unfortunately, after some time, the body compensatory mechanisms do not suffice and the unremoved substances lead to small swelling which is the first stage of lymphatic oedema.
Lymphoedema usually occurs on the limbs and around the perineum. Its development can be relatively asymptomatic even over the years. Most commonly it appears at the ankle or forefoot. At the beginning it fades when you lift your leg and it is not so visible after a good night’s sleep. The condition is more severe in the summer; the skin turns pale pink and has a slightly elevated temperature.
The affected limb deformation causes that the skin no longer protects the limb from infections, therefore even minor injuries (minor burns, bites, cuts) can intensify oedema.
At the next stage of the disease swelling can already be seen in the morning, it does not only cause discomfort in the summer but also in other seasons. The texture of the skin changes – it becomes hard, thick, horny. Lump-like growths, bulges, wrinkles and lichens begin to appear. The foot shape resembles a hoof.
Yellow, brittle, fragile and distorted nails are characteristic of lymphatic oedema. They often fall out and can also disappear completely.
The last stage of lymph retention involves the limb distortion- there is no difference between its upper and lower circumferences. The limb is so heavy that patients have to raise it with their hands, they usually cannot move either.
Elephantiasis is the most serious stage of lymphoedema. At this stage, (degenerative, necrotic) skin changes and complications appear. Oedema can reach significant sizes.
Lymphoedema therapy is a long process that can take up to several months.
Therapy includes, among others:
- skin care and protection by means of specialist creams,
- pharmacotherapy to reduce swelling,
- lymphatic drainage (special type of massage),
- compression therapy – the use of special pressure clothing,
Lymphatic drainage is a massage that is supposed to cause the lymph to move from the affected area to a healthy part of the body. Doctors may recommend medications which reduce swelling and creams which protect against infection. In the case of lymph retention, it is very important that the limb skin is given very careful and good care.
The treatment of lymphodema involves compression therapy which uses bandages and compression clothes in order to improve muscle performance therby improving the lymph flow.
Rehabilitation is also required but it must be carried out by specialists. Too intensive exercise may worsen the patient’s condition. The exercise bouts should be of high freqency but low intensity.
In the case of an advanced stage of the disease, elephantiasis, it is often necessary to undergo a surgical procedure involving the removal of swollen and hypertrophied subcutaneous tissue. Unfortunately, this method often poses a risk of complications in the form of skin necrosis. Microsurgical procedures involving the transplantation of lymph vessels and the creation of new lymphatic connections can produce good results in therapy.
Lymphoedema itself is already a serious disease. Unfortunately, it can also lead to dangerous complications. The most common complications of lymphatic oedema include:
- inflammation of lymphatic vessels,
- skin infection,
- fungal infections.