What is it?
Lymphedema is characterized by a chronic increase in the volume of a limb, related to an accumulation of lymphatic fluid. The swelling occurs when the lymphatic vessels do not drain the lymph effectively enough, which accumulates in the tissues under the skin. Lymphedema can lead to infectious, skin and rheumatological complications. There is no cure for lymphedema, but decongestant physiotherapy may slow its development. The prevalence of lymphedema is reported to be greater than 100 per 100,000.
Symptoms of lymphedema
The extent and location of lymphoedema are variable. It is clinically diagnosed when the perimeter of the affected limb is at least 2 cm higher than that of the healthy limb. It occurs most often on one arm or leg, but swelling can affect other parts of the body: the face, neck, trunk, genitals. It causes a feeling of heaviness and tension, sometimes also pain. The lymphoedema causes a thickening and a fibrosis of the skin put in evidence by the sign of Stemmer that is the impossibility to squint the skin of the 2nd toe.
The origins of the disease
Two very distinct causes are responsible for the appearance of lymphedema:
When a malformation of the lymphatic system of genetic origin is the cause, we speak of primary lymphedema. The genetic mutation is most frequently spontaneous but, in rare cases, the lymphoedema is congenital and affects several people of the same family. Primary lymphoedema affects 1 in 10,000 people and is most commonly reported at puberty.
Secondary lymphoedema refers to an acquired alteration of the lymphatic system. It may occur following surgery (removal of varicose veins or lymph nodes, for example), treatment of a tumor (such as radiation therapy to treat breast cancer), accident, or infection.
Lymphedema is distinctly different from edema of the legs . The first causes a deposit in the tissues of proteins whose lymph is rich, triggering an inflammatory reaction and a multiplication of tissues (connective and adipose), while the second consists mainly of water.
Risk factors for lymphedema
Primary lymphoedema (of genetic origin) occurs significantly more frequently in women. There is a peak incidence at puberty. On the other hand, the relation is established between the overweight and the frequency of appearance of the secondary lymphedema.
Prevention and treatment of lymphedema
To date, there is no cure for lymphedema. If it is early, decongestant physiotherapy is effective in reducing its volume and relieving symptoms, but it is very restrictive. It consists of combining the following elements:
- Lymphatic drainage by manual massage performed by a specially trained physiotherapist. It stimulates the lymphatic vessels and helps the lymph to evacuate the swelling;
- Textiles or compression bandages are applied in addition to the massage;
- After the reduction of lymphedema by massage and compression, the application of an elastic compression prevents the lymph from accumulating again;
- Specific physical exercises are also recommended by the physiotherapist.
In the absence of treatment, lymphedema progresses chronically and can cause complications such as skin infections. It can significantly alter the quality of life of the person with pain, disability and psychological consequences.