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Lymphedema

(Source: www.venenratgeber.de of 7th December 2009, Dr Uwe Schwichtenberg)

Lymphedema is often confused with chronic venous insufficiency (venous disorder). When varicose veins have been present for some time, they lead to congestion phenomena, including venous edema. This should be differentiated from lymphedema. As the Professional Association of German Dermatologists reported in haut inform 06/09, the first lymphedema related complaints sometimes already start during one's teenage years: back of feet and toes feel as if swollen and the ankle or knee become “thick”. However, the horrifying images of monstrously swollen joints should belong to the past. For matters need not reach this stage: “Diagnosed at an early stage and treated correctly, lymphedema can be tackled successfully” thus the good news according to the dermatologist and phlebologist Dr Wilfried Jungkunz from Friedburg. Lymphedema is neither “fatty deposits” nor “dropsy”. That explains why a slimming diet or dehydration therapy alone will not help. “Lymphedema is a swelling caused by a disturbance in lymphatic flow, primarily in the skin organ”, Dr Jungkunz explains.

The lymphatic system that consists of lymph nodes and lymphatic vessels has besides the role it plays in immune defence also the important function of regulating fluid transport. The lymphatic system ensures that with the protein-rich lymphatic fluid cellular debris, fats, foreign bodies, germs and metabolic products are transported back into the bloodstream. A disposition towards primary lymphedema is inherited and affects women more than men. Also following the removal of lymph nodes in the case of cancer - an acquired, secondary- lymphedema can occur. In the case of lymphedema so-called lymph stasis may occur in the dermis and sub-cutaneous fat tissue, in other words the lymph congests. In the case of chronically progressing disease increasingly connective tissue fibres that harden form and a so-called lymphostatic fibrosclerosis develops.

The first indication of lymphedema is usually swelling on the back of the feet that spreads across the ankle and the joints and is accompanied by unpleasant tension. In the beginning the swelling usually subsides over night. As the disease progresses the edema stays. Pronounced chronic lymphedema can greatly restrict daily activities and mobility and even force the patient to quit work. Additionally the patients often feel stigmatised; social withdrawal can be the result. Especially feared is so-called “elephantiasis” with horrific swelling of the joints. Blisters and fistulas from which lymph exudes can develop; they bear an increased risk of bacterial disease such as erysipelas. Lymphedema cannot be prevented, Jungkunz admits. The good news: “Early diagnosis and specialist treatment allow for the form and function of the joints affected to be retained and stop the disease from progressing". This has been shown by the years of experience of lymphological and dermatological quality circles, the expert reports.

The therapy of choice is an individually conceived, complex physical decongestion (CPD) therapy, manual lymph drainage, compression treatment and mobility exercises combined with careful skin care and, if required, skin therapy. The treatment of chronic lymphedema is usually required throughout life. “Patient care is today principally provided by locally registered lymphologically trained dermatologists, who work together with physiotherapists, Jungkunz reports. Should the outpatient therapy not have the desired effect, treatment in a lymphological specialist clinic offering round-the-clock treatment should be considered. Moreover, solid training is important where the patient learns to put on compression bandages himself or the patient learns to support lymph drainage through individual pre-treatment of the drainage area.