Clinical features

Lymphoedema is a chronic progressive disease (1).

It is characterized by swelling of the limbs (usually with involvement of the fingers) which is firm and pits poorly (2).

In the early stages of the disease there can be pitting oedema followed by fibrosis and finally irreversible swelling (1). Fibrosis particularly affects the toes and dorsum of the foot The swelling may be limited to either the proximal or the distal segment of the limb (2).

The condition is often longstanding.

One or more limbs may be affected.

Female patients of all age groups constitute 65 - 70 % of cases of primary lymphoedema.

Kaposi-Stemmer sign - inability to pinch a fold of skin on the dorsal surface of the foot at the base of the second toe is a sign of lymphedema (3).

Other than swelling patients may present with a wide variety of complaints:

• heaviness or fullness of the limb
• a tight sensation of the skin
• decreased ambulation of the affected limb
• patient may find it difficult to fit the affected area into clothing or wearing previously well-fitting rings, watches or shoes
• sleep disturbances (2)

Lymphoedema may lead to recurrent skin infection (cellulitis) which results in further damage to the lymphatic vessels and progression of the disease (1).

Reference:

• 1. National Institute for Health and Clinical Excellence (NICE). Interventional procedure overview of liposuction for chronic lymphoedema
• 2. National Cancer Institute 2008. Lymphedema
• 3. Moffatt C.J et al. Lymphoedema: an underestimated health problem. Q J Med 2003; 96: 731-738