What is lymphoedema?
Lymphoedema is limb swelling resulting from failure of the lymphatic system to transport tissue fluid via lymphatic vessels and lymph nodes. The affected limb becomes progressively more swollen, heavy and uncomfortable. As the swelling worsens, skin complications of ulceration, hyperkeratosis and fissuring develop. The limb is prone to recurrent attacks of cellulites which exacerbates the swelling further.
What causes lymphoedema?
The causes of lymphoedema are shown in the table.
Primary lymphoedema Three types determined by age of onset | Congenital (symptoms appear as an infant) | Familial (Milroy's disease) Non-familial |
| Praecox (adolescence) | Familial and non-familial types |
| Tarda (over 35 years)
| Often associated with obesity |
Secondary | Infection (commonest cause worldwide but not in the west) | Filariasis (causes elephantiasis)
|
| Cancer | Malignant obstruction of lymph nodes by metastases |
| Surgery/Radiotherapy | Especially to axilla for treatment of breast cancer |
What about other causes of leg swelling?
The main differential diagnosis is chronic venous insufficiency which can usually be excluded with duplex scanning. Isotope lymphography demonstrates sluggish lymphatic flow in lymphoedema and may indicate the site of the hold up.
Treatment of lymphoedema
The results of surgical attempts to correct lymphatic obstruction are poor. Treatment is supportive in the form of compression stockings and skin care. Attacks of cellulitis require prolonged antibiotic therapy (eg penicillin V 500mg qds for one month) and elevation during the acute early stage of the infection.
Specialist lymphoedema therapy
Once a diagnosis of lymphoedema has been confirmed by a vascular surgeon, and other problems excluded and treated, the skills of a specialist lymphoedema therapist are invaluable in controlling the condition and preventing complications.