Lymphoedema results from a failure of the lymphatic system. This can be primary (rare/congenital) or secondary due to damage to the lymphatic system. Causes of secondary lymphodema include cancer, cancer treatments (e.g. lymph node removal or radiotherapy), cellulitis, DVT, trauma.
Damage to the lymphatic system leads to an imbalance between capillary filtration into, and lymphatic drainage from, the interstitial space. Consequences are swelling, skin and tissue changes and predisposition to infection. It commonly affects the limbs, but may also affect head and neck, trunk, breasts or genitalia.
Red flags
Lymphoedematous limbs are at constant risk of infection which can worsen the swelling.
Clinical features
| Stage of lymphoedema | Clinical features |
| 0 (latent) | No visible swelling |
| 1 | Visible swelling that is soft and pitting and may subside with elevation |
| 2 | Increased swelling and elevation rarely reduces oedema. Tissues become firmer. Pitting only possible with strong sustained pressure |
| 3 | Severe swelling. Tissues increasingly fibrotic with no pitting. Deep skin folds. May be hyperkeratosis and /or papillomatosis (fibrosed lymph blisters) |
An initial approach to treatment
- Skin Care: Emolients to protect the skin and prompt management of infections.
- Self-Management: Patients should be educated on self-massage, skin care, recognising signs of infection and signposted to web-resources.
- Movement: Gentle, low-impact exercises (e.g. walking, stretching, heel raises) can enhance lymphatic circulation.
Specialist care
- Compression Therapy: Compression garments (socks/stockings and sleeves), pumps, bandaging or Velcro wraps to compress the affected areas. These helps drain fluid and reduce swelling.
- Manual Lymphatic Drainage (MLD) -the use of massage techniques to move fluid through the lymphatic system.
Top Tips
- Ideally avoid BP measurements and blood tests/cannulation in a limb affected by lymphoedema
- Diuretics rarely make a difference
- Contraindications to compression - venous thrombosis, cellulitis or cutaneous metastases