What Are the Symptoms of Lymphedema?
The swelling of lymphedema may be so slight as to barely be noticed, or the swelling may be severe and disfiguring. Pronounced swelling can be accompanied by fatigue when moving the involved extremity, as well as embarrassment.
Over the long-term, the excess fluid and proteins in the tissues cause chronic inflammation and scarring. The swelling is firm and does not retain an indentation (pit) when the skin is compressed by a finger (non-pitting edema). The skin in the involved area can become scaly or cracked, or may develop an orange-peel appearance (peau d'orange). Tenderness and soreness can accompany the swelling and skin changes. Loss of mobility may also occur.
Lymphedema also increases the susceptibility to infection in the affected area. Bacterial infections of the skin and of the subcutaneous tissues (the tissues underlying the skin) are the most common type of infections that occur in affected areas.
When to See a Doctor for Lymphedema
It is appropriate to seek medical care if you believe you have lymphedema.
How Is Lymphedema Diagnosed?
The diagnosis of lymphedema is often obvious given the history of a surgical procedure or other condition that includes damage to lymph nodes. A careful physical examination and medical history will be necessary to rule out other conditions that can cause limb swelling, such as kidney or heart failure.
In some cases, specialized imaging tests may be ordered to confirm the diagnosis or obtain information about the cause of lymphedema. These may include:
- CT or MRI scans
- Doppler ultrasound scans, which can identify deep blood clots that may cause limb swelling
- Lymphoscintigraphy, which is a test that illustrates the flow of fluid in lymph vessels. A tracer dye is injected into lymph vessels prior to imaging studies.
How Is Lymphedema Treated?
Lymphedema is not curable; although there are treatments that can help minimize the symptoms and ease discomfort.
Self-Care at Home for Lymphedema
Your health care practitioner can advise you about the best ways to care for your affected limb(s). In general, it is important to practice good skin hygiene and avoid heavy lifting or strenuous activity with the affected limb. Tight clothing and jewelry should also be avoided. Take care to avoid sunburn, insect bites, cuts, abrasions, and dehydration, since all of these can worsen lymphedema.
Surgery for Lymphedema
Various surgical procedures have been carried out, but no operation is able to cure lymphedema. When surgery is performed, the goal of treatment is the removal of excess fluid and/or scar tissue.
Medical treatment consists primarily of compression therapies to help stimulate the flow of lymph in the affected area. These must be practiced in cooperation with your health care practitioner or lymphedema therapist to ensure that they are performed correctly. There are different types of compression therapies available, ranging from compression garments and bandages to massage techniques and pneumatic compression devices. A general principle of compression therapies is that the pressure applied is greatest at the distal end (hand or foot) of the extremity and gradually decreases toward the center of the body. Your therapist may also recommend light exercises for the affected body part to help stimulate lymph drainage.
Medications are useful in the treatment of filariasis, which is the primary cause of lymphedema worldwide but rare in the U.S. Filariasis is treated with the drug diethylcarbamazine.
Antibiotics may be necessary for the treatment of secondary infections of the skin and subcutaneous tissues (see below) that are a frequent complication of lymphedema.
How Can I Prevent Lymphedema?
Primary lymphedema cannot be prevented; it is possible to take steps to reduce your risk of developing secondary lymphedema if you are at risk.
- Avoid heavy lifting (including carrying heavy purses) with an affected arm.
- Drink plenty of fluids; dehydration can worsen lymphedema.
- Avoid environmental irritants in the affected area, such asinsect bites or stings and sunburn.
- Practice good skin care and hygiene.
- Don't wear tight clothing or jewelry on the affected limb. Even the use of blood pressure cuffs on an affected arm should be avoided.
How Long Does Lymphedema Last?
As described above, lymphedema cannot be cured, although treatments are available to help manage the condition and lessen the severity of symptoms. Because the immune system is weakened in areas affected by lymphedema, bacterial infections often develop in the skin or in the tissues beneath the skin. These infections must be treated promptly to avoid spreading to other parts of the body.
A rare cancer of the lymphatic vessels known as lymphangiosarcoma can develop as a result of long-term lymphedema. Individuals who have had long-term lymphedema for 10 years or more have some risk of developing this cancer. Lymphangiosarcoma appears as a reddish or purplish lump on the skin and spreads rapidly. Treatment is amputation of the affected limb.