What is lymphoedema?
Lymphedema is the accumulation of fluid (Lymph) fat and protein under the skin. This present as swelling in the tissue in one of more of the limbs. It is predominantly found in the lower limbs but can also present in the trunk, breasts, head, neck and genitalia.
There are 2 main types of lymphoedema:
- Primary lymphoedema
This is usually an underlying genetic issue that affects the development of the lymphatic system. The individual is born with missing or malformed vessels. This usually present in adolescences.
- Secondary lymphoedema
This is more common and is caused by damage to the lymphatic system. It can be the result of disease, cancer treatment, infection, injury/trauma, inflammation of the limb, lack of limb movement, venous disease or surgery. Damage or injury to the lymphatic vessels and/or nodes prevents effective drainage and transport of the fluid in the lymphatic system around the body.
What causes lymphedema ?
The lymphatic system is part of the bodies immune system and circulates lymph fluid through the body. It helps to defend the body against infection by distributing cells, such as lymphocytes and macrophages, that combat disease. It absorbs and transports, fats, and fat-soluble vitamins, from the digestive system. Its other key function is to help keeps body’s fluid levels in balance.
After circulation, the lymph eventfully reaches a large vessel at the base of the neck, called the thoracic duct which passes the filtered lymph back into the blood circulation
Unlike blood vessels, lymphatics are one-way and eventually the circulating lump reaches the thoracic duce and the filter lumpy passes back into circulation.
When the system is damaged or diseased the lymph fluid does not drain or move around the system as intended. The body starts to accumulates fluid and may begin to swell. The swelling typically affects arms and legs, but it can affect other areas of your body and increases your risk of developing an infection.
There’s no cure for lymphoedema, but it’s usually possible to control the main symptoms using techniques to minimize fluid build-up and stimulate the flow of fluid through the lymphatic system.
What are the symptoms lymphoedama?
The main symptom of lymphoedema is swelling in all or part of a limb or another part of the body. It can be difficult to fit into clothes, and jewellery and watches can feel tight.
At first, the swelling may be soft and easy to push in, leaving a dent, and may come and go. It may get worse during the day and go down overnight. Without treatment, it will usually become more severe and persistent.
Other symptoms in an affected body part can include:
- an aching, heavy feeling
- difficulty with movement
- repeated skin infections
- developing hard, tight or thickened skin
- folds developing in the skin
- wart-like growths developing on the skin
- fluid leaking through the skin
- Signs of lymphoedema in the head and neck may include swelling or heaviness in the face, mouth or throat, and problems with swallowing and speech.
Cellulitis
If you have lymphoedema, the build-up of fluid in your tissues makes you more vulnerable to infection.
Cellulitis is a bacterial infection of the deep layer of skin (dermis) that often affects people with lymphoedema. Cellulitis can also sometimes cause lymphoedema.
Symptoms of cellulitis can include:
- redness and a feeling of heat in the skin – this may be harder to see on brown and black skin
- pain and increased swelling in the affected area
- a high temperature
- chills
Antibiotics taken by mouth (orally) can usually be used to treat cellulitis, although severe cases may need to be treated in hospital with antibiotics given directly into a vein (intravenously).
How do I manage lymphoedema?
In a small number of cases, surgery may be used to treat lymphoedema. There are 2 main types of surgery that may be useful for the condition:
- removal of fat from the affected limb (liposuction)
- restoration of the flow of fluid around the affected section of the lymphatic system – for example, by connecting the lymphatic system to nearby blood vessels (lymphaticovenular anastomosis)
Where can I find more information?
More Information on the condition can be found at:
- British Lymphology Society – www.lymphoedema.org/bls
- NHS Choices – https://www.nhs.uk/conditions/lymphoedema/
- Legs Matter- www.legsmatter.org
References:
- 1. https://www.nhs.uk/conditions/lipoedema/
- 2. Kruppa P, Georgiou I, Biermann N, Prantl L, Klein-Weigel P, Ghods M. Lipedema-Pathogenesis, Diagnosis, and Treatment Options. Dtsch Arztebl Int. 2020 Jun 1;117(22-23):396-403. doi: 10.3238/arztebl.2020.0396. PMID: 32762835; PMCID: PMC7465366.
- 3. Warren Peled A, Kappos EA. Lipedema: diagnostic and management challenges. Int J Womens Health. 2016 Aug 11;8:389-95. doi: 10.2147/IJWH.S106227. PMID: 27570465; PMCID: PMC4986968.
- 4. https://www.lipedema.org/treating-lipedema
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