What is lymphorrhea. How does lymphedema relate to fluid seepage. What causes lymph fluid to leak through the skin. How can lymphorrhea be effectively managed and treated. What are the key symptoms of lymphedema to watch for. Why is early diagnosis of lymphedema important. What treatment options are available for lymphedema and lymphorrhea.

Understanding Lymphorrhea: When Lymph Fluid Seeps Through Skin

Lymphorrhea is a condition characterized by the leakage of lymph fluid through the skin. This phenomenon is closely related to lymphedema, a chronic condition involving swelling caused by an accumulation of lymph fluid in the body’s tissues. To comprehend lymphorrhea, it’s crucial to first understand the lymphatic system and its role in the body.

The Lymphatic System: A Brief Overview

The lymphatic system is a network of vessels and nodes that plays a vital role in immune function and fluid balance. It collects excess fluid from tissues, filters out harmful substances, and returns the cleaned fluid to the bloodstream. When this system is compromised, it can lead to various issues, including lymphedema and lymphorrhea.

Lymphedema: The Precursor to Lymphorrhea

Lymphedema is a condition where excess lymph fluid accumulates in tissues, causing swelling. It typically affects the arms and legs but can occur in other parts of the body as well. This swelling can lead to discomfort, limited mobility, and in severe cases, lymphorrhea.

Types of Lymphedema

• Primary Lymphedema: A rare genetic condition caused by underdeveloped or missing lymph nodes or vessels.
• Secondary Lymphedema: More common, resulting from damage to the lymphatic system due to surgery, radiation therapy, infection, or injury.

Symptoms and Progression of Lymphedema

Recognizing the symptoms of lymphedema is crucial for early intervention and prevention of complications like lymphorrhea. What are the key indicators of lymphedema? The primary symptom is swelling in one or both arms or legs, which typically develops gradually over time. Initially, the swelling is soft and fluid-like, but it can become more dense and fibrous as the condition progresses.

Additional symptoms may include:

• A feeling of heaviness or tightness in the affected limb
• Restricted range of motion
• Aching or discomfort
• Hardening and thickening of the skin (fibrosis)
• Recurring infections in the affected area

The Transition from Lymphedema to Lymphorrhea

Lymphorrhea occurs when the lymphatic system is overwhelmed to the point where lymph fluid begins to seep through the skin. This typically happens in advanced stages of lymphedema or when the condition is poorly managed. The skin may develop small blisters or wounds that leak clear or slightly yellow fluid.

Causes of Lymphorrhea

Why does lymph fluid leak through the skin in some cases of lymphedema? There are several factors that can contribute to the development of lymphorrhea:

1. Severe swelling that puts pressure on the skin
2. Skin damage or breakdown due to prolonged lymphedema
3. Infections that compromise skin integrity
4. Poor lymphedema management
5. Underlying medical conditions that affect circulation or skin health

Diagnosis of Lymphedema and Lymphorrhea

Early diagnosis of lymphedema is crucial for preventing complications like lymphorrhea. How do healthcare professionals diagnose these conditions? The process typically involves a combination of medical history review, physical examination, and imaging tests.

Diagnostic Methods

• Lymphoscintigraphy: A scan that uses radioactive material to detect blockages or missing lymph vessels
• MRI (Magnetic Resonance Imaging): Provides detailed images of soft tissues
• CT (Computed Tomography) scan: Offers cross-sectional images of the affected area
• Ultrasound: Can help visualize fluid accumulation and tissue changes

Lymphorrhea is typically diagnosed through visual examination of the skin and assessment of fluid leakage. In some cases, fluid analysis may be performed to rule out other conditions.

Treatment Approaches for Lymphedema and Lymphorrhea

Managing lymphedema effectively is key to preventing and treating lymphorrhea. What treatment options are available for these conditions? The approach is typically multifaceted and may include:

Conservative Management

• Complete Decongestive Therapy (CDT): A comprehensive approach involving manual lymph drainage, compression therapy, exercise, and skin care
• Compression garments: Specially designed sleeves or stockings that help promote lymph drainage
• Exercise: Gentle movements that encourage lymph flow and strengthen affected limbs
• Elevation: Positioning affected limbs above heart level to promote drainage

Advanced Treatments

• Lymphatic surgery: Procedures like lymphaticovenous anastomosis or vascularized lymph node transfer to improve lymph drainage
• Liposuction: Removal of excess fatty tissue in advanced cases
• Laser therapy: Low-level laser treatment to stimulate lymph flow and reduce fibrosis

Specific Interventions for Lymphorrhea

When lymphorrhea occurs, additional measures are necessary to manage fluid leakage and protect the skin. These may include:

• Specialized dressings to absorb excess fluid
• Topical treatments to protect and heal the skin
• Intensive compression therapy
• Antibiotics if infection is present or suspected

Lifestyle Modifications and Self-Care for Lymphedema Management

Effective management of lymphedema requires active participation from the patient. What lifestyle changes and self-care practices can help prevent complications like lymphorrhea? Consider the following recommendations:

Skin Care

• Keep the skin clean and moisturized to prevent dryness and cracking
• Avoid cuts, scrapes, and insect bites on the affected limb
• Use sunscreen to protect against sunburn
• Treat any cuts or abrasions promptly to prevent infection

Activity and Exercise

• Engage in regular, gentle exercises as recommended by a healthcare professional
• Avoid activities that put excessive strain on the affected limb
• Use compression garments during exercise

Diet and Nutrition

• Maintain a healthy weight to reduce pressure on the lymphatic system
• Eat a balanced diet rich in anti-inflammatory foods
• Stay hydrated to support overall circulation

Psychological Impact and Support for Lymphedema Patients

Living with lymphedema and managing complications like lymphorrhea can have significant psychological effects. How can patients cope with the emotional challenges associated with these conditions? It’s important to address the psychological aspects of lymphedema management:

Emotional Challenges

• Body image concerns
• Anxiety about disease progression
• Frustration with ongoing treatment requirements
• Social isolation due to visible symptoms

Support Strategies

• Seeking counseling or therapy
• Joining support groups for lymphedema patients
• Educating friends and family about the condition
• Practicing stress-reduction techniques like meditation or yoga

By addressing both the physical and emotional aspects of lymphedema management, patients can improve their quality of life and reduce the risk of complications like lymphorrhea.

Research and Future Directions in Lymphedema and Lymphorrhea Management

The field of lymphedema research is continually evolving, with new insights and treatment approaches emerging. What are some of the promising areas of study that may benefit patients in the future?

Emerging Research Areas

• Genetic factors influencing lymphedema development and progression
• Novel drug therapies to stimulate lymphangiogenesis (formation of new lymph vessels)
• Advanced imaging techniques for earlier detection and more precise diagnosis
• Tissue engineering approaches to create functional lymphatic vessels
• Wearable technologies for real-time monitoring of lymphedema symptoms

These research directions hold promise for improving our understanding of lymphedema and developing more effective treatments to prevent complications like lymphorrhea.

Practical Tips for Daily Living with Lymphedema

Managing lymphedema requires ongoing attention and care. What practical strategies can patients employ in their daily lives to minimize symptoms and prevent complications? Consider the following tips:

Clothing and Accessories

• Wear loose-fitting clothing that doesn’t constrict the affected limb
• Choose shoes that fit properly and provide good support
• Avoid wearing jewelry or watches that are tight on the affected limb

Travel Considerations

• Wear compression garments during air travel
• Move and exercise regularly during long trips
• Pack necessary supplies for lymphedema management

Occupational Adaptations

• Use ergonomic tools and equipment to reduce strain on affected limbs
• Take regular breaks to elevate the limb and perform simple exercises
• Communicate with employers about necessary accommodations

By incorporating these practical tips into daily routines, patients can better manage their lymphedema and reduce the risk of developing lymphorrhea.

Lymphedema in Legs & Arms: Symptoms, Causes, & Treatment

Written by WebMD Editorial Contributors

• Causes and Types
• Symptoms
• Diagnosis
• Treatment

Lymphedema is swelling that’s caused by a collection of too much lymph fluid. It usually happens in your arms and legs, but it can happen in other parts of your body, as well. This swelling may cause pain and limit how well the affected area moves.

Lymph is a protein-rich fluid that moves throughout your body in lymph vessels. It scoops up things like bacteria, viruses, and waste, and carries them to your lymph nodes. Your lymph nodes then filter the fluid to get the impurities out of your body.

You could get lymphedema for any number of reasons. There are treatments to help bring down the swelling so you feel and move better.

If your lymphatic system is damaged or a blockage exists, the fluid can build up in the soft tissue beneath your skin.

There are two types of lymphedema:

Secondary lymphedema is caused by another condition or disease that damages your lymph vessels or nodes. Secondary lymphedema may be caused by:

• An infection in your lymph nodes
• Parasites
• Cancer or radiation treatment for cancer
• Surgery
• Lymph node removal
• Injury

Primary lymphedema is much less common. It’s a genetic problem that happens because your lymph nodes or vessels either aren’t adequately developed or are missing altogether.

The most common symptom of lymphedema is swelling in one or both arms or legs. This swelling, which can extend into the fingers or toes, usually develops gradually over time.

At first, the swelling is soft and fluid. In time, it can become more dense and fibrous, and it may make your skin look grainy. You could also have pain, heaviness, or limited range of motion in the affected limb, which may make it hard to exercise or do other activities.

Over time, these symptoms may lead to other problems including infection, and in rare cases, cancer. If swelling in your arm or leg doesn’t go away, you should see your doctor.

Your doctor will want to know about your medical history. You may also get imaging tests to help diagnose the problem.

A lymphoscintigraphy is a scan that can detect blockages or missing lymph vessels. It is done by injecting radioactive material. Other tests to investigate the cause of your swelling include MRI, CT scan, and ultrasound.

Your doctor may recommend:

• Compression garments: These fabric sleeves apply pressure to the affected limb to help lymph fluid circulate.
• Compression devices: These compression sleeves are attached to a pump that automatically applies and removes pressure on your limb on a timed schedule to prevent lymph buildup.
• Exercise: Gentle exercises may promote lymph drainage and strengthen your affected limb.
• Bandages: Wrapped in just the right way, these may help push lymph fluid toward the trunk of your body. You may also wear them to help prevent lymph fluid from going back into your affected limb.
• Massage: A specially trained professional can do light massage to help move fluid from areas of swelling to other areas where working lymph vessels may carry it away. You can even learn how to use these massage techniques on yourself.

Lymphoedema – Illnesses & conditions

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About lymphoedema

Lymphoedema is a chronic (long-term) condition that causes swelling in the body’s tissues. It can affect any part of the body, but usually develops in the arms or legs.

Other symptoms of lymphoedema can include an aching, heavy feeling in affected body parts and difficulty moving them.

Lymphoedema can get worse if it’s not treated, so you should speak to a doctor if you think you may have the condition.

Read more about the symptoms of lymphoedema and diagnosing lymphoedema

What causes lymphoedema?

Lymphoedema is caused by a problem with the lymphatic system. This is a network of vessels and glands distributed throughout the body. Its major functions are helping to fight infection and drain excess fluid from tissues.

Abnormal development of the lymphatic system, damage to it, and/or an increase in fluid in the body tissues can all lead to lymphoedema.

There are two main types of lymphoedema:

• primary lymphoedema – caused by faulty genes affecting the development of the lymphatic system; it can develop at any age, but usually occurs in early adulthood
• secondary lymphoedema – caused by damage to the lymphatic system or problems with the movement and drainage of fluid in the lymphatic system, often due to an infection, injury, cancer treatment, inflammation of the limb or a lack of limb movement 

Read more about the causes of lymphoedema

Who is affected

A recent study has suggested that over 200,000 people in the UK may be living with lymphoedema.  

Secondary lymphoedema has been shown to affect approximately one in five women after breast cancer treatment.

Primary lymphoedema is less common than secondary lymphoedema, and is estimated to affect around one in every 6,000 people.

How lymphoedema is treated

There is no cure for lymphoedema, but it is usually possible to control the main symptoms using techniques to minimise fluid build-up and stimulate the flow of fluid through the lymphatic system.

These include wearing compression garments, taking good care of your skin, moving and exercising regularly, having a healthy diet and lifestyle, and using specialised massage techniques.

Read more about treating lymphoedema and preventing lymphoedema

Complications

The build-up of fluid in the tissues of people with lymphoedema means they are more vulnerable to infection.

In particular, a bacterial infection of the skin called cellulitis is commonly reported in people with the condition.

Read more about the complications of lymphoedema

Symptoms of lymphoedema

The main symptom of lymphoedema is swelling in all or part of a limb or another part of the body, which can cause problems fitting into clothes, or jewellery and watches starting to feel tight.

At first, the swelling may come and go. It may get worse during the day and then 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
• the skin becoming hard and tight
• folds developing in the skin
• wart-like growths developing on the skin
• a leakage of fluid through the skin

When these symptoms start depends on what is causing the condition.

If lymphoedema is caused by abnormal development of the lymphatic system (a network of channels and glands distributed throughout the body that remove unwanted bacteria and particles from the body), the symptoms can develop at any age, but most commonly start during infancy, adolescence or early adulthood.

In these cases, the swelling may start on one side of the body to begin with, although the other side will usually become swollen as well over time – particularly the lower leg.

If lymphoedema is caused by damage to the lymphatic system, the symptoms can develop at any time. For example, if your lymphatic system is damaged due to treatment for breast cancer, lymphoedema may not develop for several months or even years.

Read more about the causes of lymphoedema

When to seek medical advice

If you are at risk of developing lymphoedema because you have had treatment for cancer, you may be offered an assessment for the condition as part of your treatment aftercare plan. Speak to your consultant or specialist nurse if you have any concerns.

If you think you may have lymphoedema, but not as a result of treatment for cancer, see your GP.

Read more about diagnosing lymphoedema

Causes of lymphoedema

There are two types of lymphoedema, called primary and secondary lymphoedema, which have different causes.

The main causes of primary and secondary lymphoedema are outlined below.

Primary lymphoedema

Primary lymphoedema is caused by alterations (known as mutations) in genes responsible for the development of the lymphatic system (a network of channels and glands distributed throughout the body that help fight infection and remove excess fluid from the body).

These “faulty” genes result in the parts of the lymphatic system responsible for draining fluid not developing properly or not working as they should.

Primary lymphoedema usually runs in families, but not every child born to someone with the condition will develop it themselves. 

Secondary lymphoedema

Secondary lymphoedema develops in people who previously had a normal lymphatic system.

It can have a number of different causes. Some of the most common causes are explained below.

Surgical treatment of cancer

Cancer cells can spread around the body through the lymphatic system, so part of the treatment for the condition can involve surgically removing sections of the lymphatic system potentially containing cancerous cells.

Although the surgeon will try to ensure limited damage to your lymphatic system, this isn’t always possible.

There is a particular risk of lymphoedema occurring as a complication of treatment for:

• breast cancer
• melanoma skin cancer
• gynaecological cancers – such as cervical cancer and vulval cancer
• genitourinary cancers – such as prostate cancer or penile cancer

Radiotherapy

Radiotherapy uses controlled doses of high-energy radiation to destroy cancerous tissue, but it can also damage healthy tissue.

If it’s necessary to use radiotherapy to destroy cancerous cells in your lymphatic system, there is a risk that the system could become permanently damaged and unable to drain fluid properly.

Infections

In some cases, an infection can cause lymphoedema.

Cellulitis is a bacterial skin infection that can cause lymphoedema. Severe cellulitis can damage the tissue around the lymphatic system, causing it to become scarred.

Another infectious cause of lymphoedema is a parasitic infection called filariasis. This is a common cause of lymphoedema worldwide, but is not a risk in the UK.

Inflammation

Conditions that cause tissue to become inflamed (red and swollen) can also permanently damage the lymphatic system. Medical conditions that can cause lymphoedema include:

• rheumatoid arthritis – which causes pain and swelling in the joints
• eczema – which causes the skin to become itchy, reddened, dry and cracked

Venous diseases 

Venous diseases, which affect the flow of blood through the veins, can cause lymphoedema in some people. The abnormal or damaged veins can result in excessive fluid leaking from the blood into the tissue spaces. This overwhelms and eventually exhausts the parts of the lymphatic system responsible for draining this fluid.

Some venous diseases that can lead to lymphoedema include:

• deep vein thrombosis (DVT) – a blood clot in one of the deep veins in the body
• varicose veins (swollen and enlarged veins) – where poor drainage of blood in the veins causes higher vein pressure, and more fluid passes into the surrounding tissues

Obesity

People who are obese, particularly those who are severely obese, have an increased risk of developing lymphoedema. It’s not clear exactly why this is, but it has been suggested that the extra fatty tissue affects the lymphatic channels in some way, reducing the flow of fluid through them.

In these cases, weight loss is an important part of treatment and even just starting to lose weight can make a big difference.

Trauma and injury

In a small number of cases, lymphoedema can be caused by an accidental injury to the lymphatic system. For example, lymphoedema can sometimes occur after extensive soft tissue loss or bruising.

Immobility

Movement and exercise helps lymph drainage, as muscle activity surrounding the lymphatic vessels massages fluid into and along them. Therefore, reduced movement can lead to lymphoedema, because the fluid in the lymphatic system does not get moved on, causing swelling.

For example, people who are unable to move fully for a long time due to an illness or surgery may be at risk of lymphoedema.

Diagnosing lymphoedema

If you’re being treated for cancer and are at risk of developing lymphoedema, you’ll be monitored for the condition afterwards. Otherwise, see your GP if you experience symptoms of swelling.

There are a number of specialist lymphoedema treatment centres in the UK. Your doctor may refer you to one of these for further assessment. A list of treatment centres near you is available from the Lymphoedema Support Network.

In many cases, it’s possible to make a diagnosis of lymphoedema by:

• asking about your symptoms and medical history
• examining the affected body part and measuring the distance around it to see if it’s enlarged 

Further tests

Although not necessary in most cases, further tests may occasionally be used to assess and monitor your condition. These tests are explained below.

Measuring limb volume

In some cases, tests to calculate the volume of an affected limb may be carried out. These may include:

• a tape measure to measure the circumference of the limb at certain intervals, to calculate its volume
• water displacement – where you place the affected limb in a tank of water and the amount of water that is displaced is measured to calculate the volume of the limb
• perometry – infrared light is used to measure the outline of an affected limb and calculate its volume

Bioimpedance testing

During a bioimpedance test, electrodes (small metallic discs) are placed on different parts of your body. The electrodes release a small and painless electric charge that is measured using a handheld device. Changes in the strength of the current can indicate the presence of fluid in your tissue.

Imaging tests

Imaging tests may also be used to help diagnose and monitor lymphoedema. These include:

• a lymphoscintigraph – you are injected with a radioactive dye that can be tracked using a special scanner; this shows how the dye moves through your lymphatic system and can check for any blockages
• a magnetic resonance imaging (MRI) scan – which uses a strong magnetic field and radio waves to produce detailed images of the inside of your body 
• an ultrasound scan – which uses high-frequency sound waves to create an image of the inside of your body
• a computerised tomography (CT) scan – which uses X-rays and a computer to create detailed images of the lymph nodes

These scans can be used to create a clearer picture of the affected tissue.

Treating lymphoedema

The recommended treatment for lymphoedema is decongestive lymphatic therapy (DLT).

DLT is not a cure for lymphoedema, but it can help control the symptoms. Although it takes time and effort, the treatment can be used to effectively control your lymphoedema.

Decongestive lymphatic therapy (DLT)

There are four components to DLT:

• compression bandages and garments – to move fluid out of the affected limb and minimise further build-up
• skin care – to keep the skin in good condition and reduce the chances of infection
• exercises – to use muscles in the affected limb to improve lymph drainage
• specialised massage techniques – known as manual lymphatic drainage (MLD) – to stimulate the flow of fluid in the lymphatic system and reduce swelling

Each of these components is described in more detail below.

DLT usually begins with an intensive phase of therapy, during which you may receive daily treatment for several weeks to help reduce the volume of the affected body part.

This is followed by the second phase, known as the maintenance phase. During this, you will be encouraged to take over your own care by carrying out simple self-massage techniques, wearing compression garments and continuing to exercise. This phase of treatment aims to maintain the reduced size of the affected body part.

You may then have reviews every few months to check how your treatment is progressing.

Compression bandages and garments

Unlike the blood circulation system, there is no central pump, such as the heart, to move fluid around the lymphatic system. Instead, the lymphatic system uses the massaging effect of surrounding muscles to move the fluid.

If you have lymphoedema, you will have special bandages or garments (such as sleeves, gloves, stockings or tights) fitted over any affected limbs. These will support the affected muscles during exercise and encourage them to move fluid out of the affected limb.

These may also be applied after a session of MLD, to prevent fluid accumulating in the limb again. This use of compression bandages and garments is known as multilayer lymphoedema bandaging.

Velcro wraps may be used instead of bandages and have the advantage that the person with lymphoedema can apply them themselves.

You will be taught how to correctly apply your own bandages and compression garments, so you can continue to use them during the maintenance period.

Skin care

Taking good care of your skin is important, because it will reduce your risk of developing an infection, such as cellulitis.

Read our page on preventing lymphoedema for more skin care advice.

Movement and exercises

Your lymphoedema care team will help devise an exercise and movement plan designed to strengthen and stimulate the muscles involved in lymph drainage. They will also help you to lose weight, if you are overweight. This will be tailored to your requirements and ability.

Your plan may involve specific limb exercises, as well as gentle activities that involve the whole body, such as swimming, cycling and walking.

Massage

To begin with, you may receive specialised massages called manual lymphatic drainage (MLD) – usually carried out by a specialist therapist – to move fluid from the swollen areas into working lymph nodes, where it can be drained.

Your lymphoedema therapist will also teach you a range of simpler massage techniques that you or your carer can use during the maintenance phase of treatment, to help keep the swelling down. These self-massage techniques are known as simple lymphatic drainage (SLD).

Surgery

In a small number of cases, surgery may be considered to treat lymphoedema. There are three main types of surgery that may be useful for the condition:

• the removal of sections of excess skin and underlying tissue (debulking)
• the removal of fat from the affected limb (liposuction) – see below
• the 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)

These treatments may help to reduce the size of areas of the body affected by lymphoedema, but some are still experimental – particularly lymphaticovenular anastomosis – and are not in widespread use.

Liposuction

Liposuction is where a thin tube is inserted through small incisions in the skin to suck fat out of tissue. It can be used to remove excess fat from an affected limb to help reduce its size.

Once the surgery is complete, you will have to wear a compression garment on the affected limb day and night for at least a year to help keep the swelling down.

The National Institute for Health and Care Excellence (NICE) states that liposuction for chronic (long-term) lymphoedema appears to be safe, and may be effective in the short term. However, NICE says there is not enough evidence of its long-term effectiveness and safety.

Access to liposuction for lymphoedema may be limited, depending on what is available from your local NHS Clinical Commissioning Group (CCG).

Complications of lymphoedema

Cellulitis is the most common complication of lymphoedema, but psychological issues can also occur as a result of the condition.

These complications are explained below.

Cellulitis

Many people with lymphoedema experience repeated episodes of cellulitis (also known as erysipelas). Cellulitis is a bacterial infection of the deep layer of skin (dermis) and the layer of fat and soft tissues (the subcutaneous tissues) that lie underneath the skin. Cellulitis can occur as a result of lymphoedema and can also cause the condition.

Symptoms of cellulitis can include:

• redness and a feeling of heat in the skin
• pain in the affected area
• a high temperature (fever)
• chills

Cellulitis can usually be successfully treated with antibiotics, although severe cases may need to be treated in hospital.

In some cases, you may be provided with a short supply of antibiotic tablets to use as soon as you notice symptoms of cellulitis. Alternatively, you may be given a long-term course of antibiotics to take to prevent infection.

Psychological impact

Living with a chronic (long-term) condition that affects your appearance, such as lymphoedema, can cause a great deal of distress and lead to periods of depression.

If you have been feeling particularly down for the last few months and you no longer take pleasure in the things you usually enjoy, you may be depressed. If this is the case, talk to your GP or members of your lymphoedema treatment team, because there are effective treatments for depression.

Talking to other people who also have lymphoedema can be reassuring and decrease feelings of isolation, stress and anxiety. The Lymphoedema Support Network offers information and advice, and can put you in touch with a support group in your area.

Remember: if you persevere with your treatment plan, your symptoms should eventually become less noticeable. 

Read more about treating lymphoedema

Preventing lymphoedema

It’s not possible to completely prevent lymphoedema, but the following steps may help reduce your chances of developing the condition.

If you already have lymphoedema, this advice may stop it getting worse.

Skin care

The part of your body affected by lymphoedema is more vulnerable to infection of the build-up of fluid within the tissues. Any cuts in your skin can allow bacteria to enter your body and may quickly develop into an infection.

Skin infections can also damage your lymphatic system and cause lymphoedema to develop.

You can reduce your chances of developing skin infections by:

• not having injections or blood pressure readings in the affected area whenever possible
• treating cuts and scratches immediately with an antiseptic cream
• using insect repellents to prevent insect bites
• moisturising the skin daily to keep it supple – your GP can prescribe a suitable cream
• avoiding very hot baths and showers – the heat from saunas, steam rooms and sun beds may also increase the swelling
• using sun cream with a high sun protection factor (SPF) to prevent sunburn
• wearing gloves for gardening and household tasks to avoid cuts, if your upper limbs are affected
• using anti-fungal powder to prevent fungal infections in your skin or feet, if your lower limbs are affected
• cutting your nails with nail clippers
• seeing a chiropodist for foot and nail care – but make sure you tell them you have lymphoedema
• wearing shoes that fit correctly and provide support on the top of your feet, if your lower limbs are affected
• using an electric razor if you need to shave to reduce the risk of cutting yourself
• not wearing tight-fitting clothes or jewellery 

Contact your GP as soon as possible if you develop symptoms of a possible skin infection, such as redness and a feeling of heat in the skin.

Healthy lifestyle

Adopting a healthy lifestyle may also help reduce your risk of developing lymphoedema, and may help control the condition if you already have it.

This includes:

• eating a healthy diet
• maintaining a healthy weight
• exercising regularly

Lymphostasis: the possibility of long-term control of complex pathology

Article published on p. 14-16 (World)

Lymphedema (lymphostasis) is a dysfunction of the lymphatic system, which is based on the difficulty of outflow of lymph from the affected part of the body. This pathological process has a progressive course and takes place in several stages. Lymph is formed from interstitial fluid. Therefore, the initial manifestation of lymphostasis is interstitial edema. In addition to fluid and electrolytes, lymph contains lymphoid cellular elements, tissue metabolites, fats and protein, as well as antigens, antibodies, and immune complexes. Therefore, interstitial edema in lymphostasis is mediated by hydrostatic, osmotic, and also oncotic mechanisms. In addition to edema, tissues are affected by all lymph components that cannot be eliminated into the bloodstream during lymphostasis. Lymphoid cells, essential immune compounds, tissue metabolites, toxins trigger the inflammatory process, destruction of lymphatic capillaries and tissues. Accession of infection greatly accelerates the pathogenesis of lymphostasis, which ends with the destruction of the affected part of the body.

Lymph is a fluid with a high protein content. As a result of impaired drainage of the lymph, irreversible changes occur in the form of replacement of exudate saturated with proteins with fibrous tissue. As fibrosis progresses, the skin takes on the appearance of an “orange peel”, pigmented areas and warty growths appear. The surface of the limb becomes uneven, resembling paving stones; as a result of local lymphostasis, multiple papillomas form in the dermis. This type of limb is called “elephantiasis”. In lymphedematous tissue, the movement of cells, including lymphocytes and macrophages, is disrupted, which leads to a decrease in the immune response of the tissue and recurrent inflammatory processes. Lymphedematous tissue can also be a source of autoimmune reactions and sarcomatous process. This highlights the need for ongoing supportive treatment of lymphedema to prevent recurrent inflammation and malignancy (Stewart-Treves syndrome, aggressive lymphangiosarcoma).

Lymphostasis develops in any part of the body from which, for one reason or another, the outflow of lymph is disturbed. Known congenital, or primary, lymphedema, detected both immediately after birth and in a later period.

1 shows primary lymphedema of the right upper limb in a 4-year-old child.

Most often, lymphedema is secondary and occurs as a result of damage to the lymphatic system during trauma, surgery, neoplasms (cancer of the breast, pelvic organs, chest cavity), as well as after radiation and chemotherapy. In malignant neoplasms, the risk of developing lymphedema is 15.5%.

Regardless of the cause that led to lymphostasis, the development of lymphedema causes a serious dysfunction of the affected part of the body, reduction and disability and disability of the patient. Depression accompanies lymphedema almost always.

Currently, lymphedema is considered an incurable disease. Nevertheless, there are methods of treatment that allow for a long time, sometimes decades, to control the disease, while maintaining the affected body part and its function.

Treatment of lymphedema is always more effective when started as early as possible. Hence the need for the earliest possible diagnosis.

Diagnosis of lymphedema involves both general clinical and a number of specific diagnostic measures.

Medical history and physical examination. The physician should carefully consider the history of the onset of edema, the time and duration of the disease, genetic history, previous diseases and operations. Conduct an examination of the patient and preliminary differential diagnosis with other diseases in which edema may occur (diseases of the heart, liver, blood).

Volume measurement. Measurement of the volume of a limb (arm or leg) is a long-term indicative diagnostic method, since an increase in the volume of a limb is the result of the manifestation of lymphedema. There are three types of measurement – tape, pyrometry and water exchange. The disadvantage of this method is the impossibility of differentiating lymphatic and venous edema.

Doppler ultrasonography and Doppler sonography can visualize blood flow in veins and arteries, detect areas of impaired blood flow, identify venous/arterial thrombosis, and visualize blood clots and plaques in arteries. These methods allow you to determine the non-lymphatic causes of edema.

Magnetic resonance imaging (MRI), computed tomography (CT) will show an excess of tissue fluid, but also will not indicate the causes of interstitial edema. Therefore, they are additional and auxiliary methods.

Examination of the lymphatic vessels allows you to definitely say whether this edema is lymphatic.

Lymphoscintigraphy, or lymphangioscintigraphy (LAS). Proven diagnostic value is isotope lymphography, which is also called lymphoscintigraphy or lymphangioscintigraphy. It allows you to visualize the network of lymphatic vessels. For the study, an injection of human serum albumin labeled with 99MTs. LAS has replaced lymphography, which is potentially unsafe because it can cause allergic reactions and worsen the course of the disease.

Bioimpedance spectroscopy (BIS) is a method for studying the composition of fluid in tissues. It is mainly used in determining the composition and volume of fluid in fitness, with obesity. It does not allow to distinguish lymphatic edema from venous.

Laboratory blood tests are not informative as they cannot confirm/exclude lymphedema.

As a result, the correct primary diagnosis of lymphedema is based on the doctor’s attentiveness to the collected anamnesis, examining the patient and measuring the volume of the limb.

Treatment of Lymphedema

The current gold standard for the treatment of lymphedema is Complete Decongestive Therapy (CDT).

It consists of two phases – reductive and supporting.

In the first, reductive, phase, it is necessary to reduce the area of ​​tissue damage – reduce swelling, increase lymphatic drainage from the affected area, reduce skin fibrosis and improve skin condition.

The second phase is supportive care. Lymphedema is an incurable disease. But properly selected combined supportive therapy allows you to control the process, eliminate discomfort, improve the patient’s physical and moral status and quality of life, as well as reduce the risk of developing cellulite, Stewart-Treevs syndrome, and angiosarcoma.

Treatment in the first phase

Optimal treatment lasts from 5 days to 3-8 weeks, until the volume of the affected body part normalizes and the condition of the skin above it improves. Let’s consider its components.

Manual lymphatic drainage (MLD). Manual drainage is a special massage technique that uses metered manual pressure to stimulate the outflow of lymph, redistribute fluid in order to reduce the volume of the limb. The RLD technique is different from ordinary muscle massage. RLD is aimed at stimulating superficial lymphatic vessels and returning interstitial fluid, as well as stimulating the movement of fluid through subepidermal channels that form when the lymphatic system is damaged. RLD is a technique of light superficial skin massage aimed at moving lymph through the subcutaneous channels to functioning lymphatic vessels and lymph nodes and further stimulating the movement of lymph through the lymphatic vessels. RLD is carried out by a specially trained specialist, since massage of insufficient strength will not have an effect, and massage with high pressure can lead to rupture of the lymphatic collectors and aggravate the course of the disease.

Compression bandage. The compression bandage is a special technique using several types of materials to create an effective pressure gradient. These materials are designed according to the banding technique. Bandages with a low degree of extensibility are used, stretching up to 40% of the length. Bandaging is performed with high pressure on the distal parts of the limb and weakening the pressure in the proximal direction. The pressure under such a bandage is low when the patient is at rest (resting pressure). During movement and muscular work, the pressure under the dressings increases, the so-called muscle pump turns on, which contributes to the movement of interstitial fluid into the vascular circulatory bed. In the future, a low-elastic bandage prevents the return of fluid from the vessels to the tissues, prevents edema and the development of fibrosis. Bandaging is carried out in the first phase of treatment. But some patients need such a bandage for a long time. Some types of lymphedema, in particular the head and neck, cannot be bandaged. They use special treatments.

Circaid is an innovative device for variable dosed compression of an affected limb with lymphedema. If it is impossible to change the degree of compression when using standard compression bandages, then Circaid allows you to adjust it in the range of 10–40 mmHg.

Compression stockings (compression underwear). In the complex treatment of lymphedema, compression stockings are also used. As a rule, these are flat knitted products made individually, based on the size of the patient’s limb and the required pressure.

Intermittent pneumatic compression massage. Intermittent (alternate) compression massage (ICM) has been used for a long time, in recent years it has been improved, it allows you to regulate pressure and the movement of lymph and blood. In the treatment of lymphedema, it is recommended to set the cuff pressure to 30–60 mmHg. The procedure lasts 1 hour. During the procedure, fluid may seep through the skin, soaking the dressings. The doctor, at his discretion, can reduce or increase the pressure in the pumps. ICM is used in the first phase, recommended for intermittent treatment in the second phase. We use intermittent compression pneumomassage using Lymphopress devices made in Israel.

Lyoton 1000 gel in the treatment of lymphedema

For ten years in our clinic we have been using Lyoton 1000 gel containing heparin at a high concentration of 1000 IU/g. The use of Lyoton 1000 gel is justified by its beneficial pharmacodynamic effects: anti-edematous, anti-exudative, anti-inflammatory and anticoagulant. The anti-edematous, anti-exudative and anti-inflammatory effect of Lyoton 1000 gel is in demand, taking into account the pathogenesis of lymphedema. The anticoagulant effect of the drug is important to prevent damage to the superficial venous system. The drug prevents thrombosis of superficial veins, which is a good prevention and treatment of microcirculatory disorders in the affected area. It is important that Lyoton 1000 gel does not have a systemic anticoagulant effect.

When bandaging the limb, as well as before putting on compression stockings, we use Lyoton 1000 gel. Lyoton 1000 gel is applied to clean skin over the entire affected area with a thin layer, after which bandaging is carried out according to the standard method. Due to the anti-exudative, anti-edematous and microcirculatory action, Lyoton 1000 gel enhances the effectiveness of bandaging. In comparison with the use of Lyoton 1000 menthol ointment, the gel provides a significantly greater (by 15%) reduction in the volume of the affected limb.

Treatment in the second phase

Upon completion of the first phase, the patient with lymphedema is transferred to a permanent maintenance treatment. It includes wearing special compression clothing, self-care of the skin, exercises. Compression garments should be changed every 4-6 months. Under compression hosiery or bandage, it is advisable to apply Lioton 1000 gel 1-2 times a day. Exercises for lymphatic drainage are developed individually. All exercises are aimed at strengthening the work of the muscle pump, improving microcirculation and reducing swelling. The patient needs to pay attention to nutrition, weight control. Regular monitoring of the course of the disease by the attending physician, periodic sessions of compression therapy, diet, and, if necessary, weight loss are necessary.

Surgical treatment of lymphedema is rare, associated with a high risk of complications and unstable results. Without fail, it is carried out as part of the general complex of therapeutic measures.

Medical treatment cannot be independent.

Diuretics are used with great care to reduce swelling. Basically, diuretics are ineffective, and often even harmful, as they can increase the concentration of protein in the interstitial fluid.

In case of infection, antibiotics are prescribed, the water-salt balance is corrected, anemia and other comorbidities are treated. Recommended drugs to improve microcirculation.

Conclusions

Despite the complexity of the pathological process, treatment and long-term control of lymphedema are possible. Correct and timely diagnosis, early start of treatment, its complexity and continuity are the factors that allow achieving good and stable results in the treatment of lymphedema.

Just swelling or extra fat? How to understand what actually causes weight gain

• Health

Most often we swell in the morning. Some problem areas are both on the face and on the body. Why they appear, how to properly get rid of edema, the beautician explains.

January 31, 20221

Source:

pexels.com

When we sleep a lot (or, conversely, too little), eat salty, fatty or too high-calorie food in the evening, then in the morning, most likely, an unpleasant surprise will await us: a swollen face. For everyone, this effect manifests itself in different ways. Someone notices that only the area under the eyes swells – in such cases, patches are often used to eliminate swelling. For someone, the swelling “spreads” all over the face and disappears only after a few hours. They save themselves from it in different ways: they wipe the skin with ice cubes, take a contrast shower, make refreshing sheet masks. And sometimes the edema pours out not only on the face, but also on the whole body.

Dermatovenereologist, cosmetologist Irina Orlova told Doctor Peter about why edema appears, how not to confuse them with extra pounds and when it’s time to see a doctor.

About the causes of edema

“Edema on the face and body appears due to impaired venous or lymphatic outflow. In fact, this is a whole cascade of reactions, as a result of which fluid accumulates, metabolic and trophic processes are disrupted, ”explains the expert.

There are many reasons for the formation of edema, this is generally a common medical problem. Most often they appear due to malnutrition, excessive consumption of salty foods, lack of protein in the body or, conversely, its excess.

In addition, there are edema associated with weakness of the vascular wall.

“In this case, we observe perspiration — this is the process of “leakage” of blood plasma through the walls of blood vessels, when their permeability increases. Edema is often confused with excess weight, this fact is quite logical: after all, when we swell, we visually increase in volume, ”says Irina Orlova.

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Edema and excess weight

Distinguishing permanent edema from extra pounds is not at all difficult. It is enough to perform a few simple steps, says the beautician.

“Swelling has certain symptoms. So, the skin becomes pasty In this case, when pressing with a finger, a hole remains on the skin, which then slowly, slowly recovers. Skin turgor is reduced, respectively, due to the accumulation of fluid in the tissue, it becomes less elastic.

If we are talking about swelling on the body, then in the places where the cuff or tight elastic band fits, a clear mark remains on the skin, which then also recovers for a long time. Plus, , the skin becomes paler , especially in places where there is some kind of pressure, ”explained Irina Orlova.

“Age” swelling

The older you get, the more likely it is that both your face and body will swell in the morning. This unpleasant fact also has an explanation.

“With age, the likelihood of edema increases. Doctors distinguish a separate morphotype of age-related changes – deformation-edematous , where the mechanisms of aging are based on a violation of the inflow and outflow of fluid through the vessels and tissues of the face. Edema that appears on the body is most often due to a lack of physical activity – and, as a result, a weak vascular wall. After all, various exercises strengthen not only the muscles of the body, as is commonly believed, but also the muscle layer in the vessels, ”says the cosmetologist .

The process of edema appearance looks like this: muscle fibers pass through the wall of the vessel, which pump blood and lymph. If they are weakened, skin tone is noticeably reduced. As a result, the body cannot cope with the pumping of the required volume of blood, fluid leaks into the tissues and edema develops.

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How to deal with them

When a patient comes to a cosmetologist with complaints of edema, the specialist, first of all, needs to determine the cause of their appearance, and only then prescribe any procedures.

“To do this, I will ask how often and after what edema appears, I will collect all the necessary anamnesis. In some cases, it may be necessary to consult a general practitioner or endocrinologist. If there are no medical and physiological reasons for the formation of edema, we recommend reconsidering nutrition, lifestyle, physical activity, ”says Irina Orlova.

Cosmetic procedures can help get rid of edema. They are able to influence the microvasculature, thereby improving the functioning of blood vessels.

“So, if a woman complains about constant swelling on her face, we carry out course procedures: lymphatic drainage massage, microcurrent therapy, plasmolifting.