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Stages of Lymphedema

Lymphedema does not occur overnight but develops insidiously. However, once edematization has begun, the process will continue if left untreated. This is amongst other things connected with the fact that the skin´s defence function deteriorates because of lymphedema. Bacterial skin infections, such as eg erysipelas can develop, which in turn affect the lymphatic vessels. The edema worsens.

There are different degrees of severity relating to lymphedema. The severity depends on the stored amount of lymph fluid in the tissue. In the early stages the swollen skin area still clearly indents when pressed with the thumb. If the indentation does not disappear immediately again, this indicates edema. In more advanced stages the swelling has developed to such an extent that the extremities appear totally deformed. This condition leads to a worse defence function of the skin. That is why lymphedema tends to lead in more advanced stages to bacterial skin infections, such as erysipelas. These infections in turn affect the lymphatic vessel system and thus worsen lymphedema.
The development of lymphedema can be divided into the following four stages.

Stage 0: Latent Edema

The lymphatic vessel system has already sustained damage and already functions on a reduced level. It can still however make up for lymph drainage conditions. Edema is not (yet) present.

Stage I: Reversible Edema

The lymphatic vessel system can´t cope. Soft tissue swelling occurs mainly in the evening. The swelling can be fully reversed overnight or after a few days with limb elevation.

Stage II: Chronic irreversible edema

The swelling has clearly hardened. The skin no longer indents when pressed and the edema cannot be reversed after longer periods of rest.

Stage III: Elephantiasis

The swelling takes on extreme dimensions. The leg is badly deformed. The skin is hard and characterized by wart-like outgrowths. Due to the development of lymph sacks and excessive bulging there is increased danger of erysipelas.