Lymphedema is the swelling of the skin and underlying structures below the skin, due to accumulation of a fluid called Lymph. Our Lymphatic system circulates protein-rich lymph fluid throughout our body, collecting bacteria, viruses, and waste products, through the lymph, vessels, which lead to lymph nodes. The wastes are then filtered out by the infection-fighting cells, the lymphocytes, that live in the lymph nodes and are finally flushed out from your body.
Due to damaged lymphatic system, patients with lymphoedema have frequent attacks of infection causing high fever and severe pain. Patients may be bed-ridden for several days and normal routine activities become difficult.
Lymphedema occurs when your lymph vessels are unable to adequately drain the lymph fluid, usually from an arm or leg. Lymphedema may be either primary or secondary.
Primary lymphedema is a congenital condition that is caused by problems with the development of lymph vessels in your body. Symptoms may occur at birth or later in life.
Secondary lymphedema is caused by any condition or procedure that damages the lymph nodes or lymph vessels. The causes include tumor, surgery, post-irradiation fibrosis, infection, filariasis, thyroid disease, obesity, and chronic venous insufficiency.
The following are the major risk factors for this condition :
Malignancies and/or associated treatments are the major cause of secondary
lymphedema in developed countries.
Filariasis is the most common global cause of secondary lymphedema.
Older age, rheumatoid or psoriatic arthritis, slow healing of the skin after surgery.
A tumor that affects or blocks the left lymph duct or lymph nodes or vessels in the
neck, chest, underarm, pelvis, or abdomen.
Obesity and postoperative weight gain
Filariasis being a mosquito borne disease people are only affected in regions with infected mosquitoes. Many mosquito bites over several months to years are needed to get lymphatic filariasis. And therefore, people living for a long time in tropical or subtropical areas where the disease is common are at greatest risk for infection. The prevalence of the disease is also associated with gender with males getting infected more than females.
Lymphatic Filariasis is caused by infection with the parasitic nematodes and is transmitted through mosquitoes. Not all people infected with lymphatic Filariasis develop lymphedema but when they do the swelling can be so severe, and the skin changes so discernibly, it is called ‘elephantiasis.’ Lymphoedema patients, predominantly villagers get infection due to their prolonged exposure to open spaces, green lands, and small canals, which are the major reservoirs of the mosquito vector.
In the initial stages, Lymphedema resembles general edema and can be misinterpreted as general swelling or edema. During the beginning stages, pitting is clear, the skin is soft, and limb elevation assists in resolving the edema. In the later stages, pitting ceases to be visible, the skin hardens, and limb elevation does not reduce the swelling.
Major symptoms include :
• Nontender, pitting edema of the affected area
• Inability to pinch a fold of skin at the root
• swelling in the extremities including the arms, hands, legs, feet
• swelling proximally in the breast, chest, shoulder, pelvis, groin, genitals, face
• restricted range of motion in the joints because of swelling and tissue changes
• skin discoloration
• pain and altered sensation
• limb heaviness