Lymphoedema is a medical condition caused when there is damage to the lymphatic system. One of the jobs of lymphatic system is to take away extra fluid from the body. If the lymphatics aren't working properly, then that fluid can't get out, and it will build up in the part of the body that isn't draining properly, and it gets swollen. This is a problem because the fluid is rich in protein. The body uses protein as building blocks, so too much protein can cause the skin and tissues to change. The skin may become stretched and weak, and the tissues may get harder. Some of the changes that might be seen can include:
splits in the skin
pain, heaviness and discomfort
increased risk of fungal and bacterial infections, including a high risk for cellulitis.
Not being able to move around easily, so not being able to work or look after yourself.
There is no cure or medication for lymphoedema; it is a life long condition and needs to looked after well. Go to Treatment
Stages of Lymphoedema
Stage 0 – Subclinical stage
When the damage is done to the Lymphatic system.
There is no sign of swelling or oedema.
Stage 1 – Reversible stage - Treatment is most effective if started at this stage
The tissues are soft and swollen with fluid;
Pressing on the the swelling will leave a dent as the fluid moves away when pressed on. This is called "pitting".
Appears during the day, may go back down when sleeping
Raising the arm or leg may help to bring the swelling back down.
Stage 2 – Spontaneously irreversible stage
The arm or leg stays swollen, even if raised.
Skin may feeler harder. This is called fibrosis. The built up fluid has a lot of protein in it, which makes the skin thicker.
Pitting goes away, so pressing on the skin doesn't leave a dent anymore.
Stage 3 – Lymphostatic elephantiasis
Swelling gets much worse
Fibrosis or hardened skin gets worse
Dramatic skin changes -
change in colour, how it feels, there may be growths
High risk of infection (Cellulitis)
Reduced mobility contributes to poor healing rates
Some people are born with lymphoedema (primary lymphoedema), while others may get it from another cause (secondary lymphoedema or SLO). Primary lymphoedema (PLO) is the congenital form of the disorder. This means that the person was born with a lymphatic system that may not work properly. It is more common in the lower body than the upper body. Typically, it's caused by one or more of these:
not enough lymph vessels (Hypoplasia)
too many lymph vessels, become rigid and valves can’t function (Hyperplasia)
lymphatic vessels and/or nodes missing (Aplasia)
Lymph vessels that are too wide (Lymphangiectasia)
While some people shows signs from when they are born or in childhood, most won't show symptoms until they are in puberty or even adulthood, and the onset is usually triggered by an event, such as:
Injury or surgery
In 96% of cases of PLO, the cause is called Spontaneous, with no genetic history, which means that no one else in the family has had it. In about 4% of cases, someone else in the family will have it. including
Nonne-Milroys: present at birth
Meige’s Disease: presents in childhood or around puberty
Primary Lymphoedema can also be present with other conditions, including:
Ulrich Turner Syndrome
Gorham Stout Syndrome
Secondary lymphoedema is the most common form of lymphoedema in NZ, and it happens when something happens to the lymphatic system and damages it. Damage can be caused by a number of different things, including:
Surgery - particularly if lymph nodes are removed, which is why we see so many cases in people that have had surgery for cancer
Malignant Lymphoedema - caused by tumour blocking lymph flow
Filariasis infection (in tropical countries)
Some medicines can cause Oedema too. Talk to your doctor about possible side effects of any medications you are on. Below are examples of some medications known to contribute to oedema. Sodium overload/retention,
medications with high levels of sodium and sodium bicarbonate (eg antibiotics)
Exacerbation of pre existing renal dysfunction
NSAIDs, anti-hypertensives, and anticancer drugs may bring on oedema in patients with renal dysfunction.
Increasing vascular permeability
Calcium antagonists, insulin etc contribute to hyper-permeability