What is Lymphedema?

Upper Extremity Lymphedema; before and after treatment.
Lymphedema is the swelling of a body part, most often the extremities. It can also occur in the face, neck, abdomen or genitals. Lymphedema is the result of the abnormal accumulation of protein rich edema fluid in the affected area. Remarkably, even though it afflicts approximately 1 percent of the U.S. population (2.5 million Americans), its seriousness and the problems it creates are poorly understood in the medical community.

Lymphedema Therapy Certification
Lymphedema is classified as either primary or secondary. Primary lymphedema is the result of lymphatic dysplasia. It may be present at birth, but it more often develops later in life without obvious cause. Secondary lymphedema is much more common and is the result of surgery and/or radiation therapy for cancer. Secondary forms may also occur after injury, scarring, trauma or infection of the lymphatic system. Lymphedema has important pathological and clinical consequences. In stage I lymphedema, the swelling consists of protein-rich fluid and may become temporarily reduced by simple elevation of the limb. If it remains untreated, however, the lymphedema causes a progressive hardening of the affected tissues, which is the result of a proliferation of connective tissue, adipose tissue and scarring (stage II lymphedema). Stage III lymphedema is characterized by a tremendous increase in volume, hardening of the dermal tissues, hyperkeratosis and papillomas of the skin. Infections such as cellulitis, erysipelas or lymphangitis frequently develop in patients suffering from lymphedema. Infections are most common in stage II and III lymphedema, each infection resulting in a worsening of the condition and necessitating frequent hospitalizations. The most effective treatment for lymphedema is Manual Lymph Drainage (MLD) and Complete Decongestive Therapy (CDT).

Treatment of Lymphedema

Complete Decongestive Therapy (CDT)

Manual Lymph Drainage (MLD)


Medications & Prescriptions

Compression Pumps

Guidelines for Patients

NOTE: The following recommendations have been made by the National Lymphedema Network (NLN) for patients with lymphedema and for those who are at risk to develop lymphedema.

I. Skin Care – Avoid trauma / injury to reduce infection risk

  • Keep extremity clean and dry
  • Apply moisturizer daily to prevent chapping/chafing of skin
  • Attention to nail care, do not cut cuticles
  • Protect exposed skin with sunscreen and insect repellent
  • Use care with razors to avoid nicks and skin irritation
  • If possible, avoid punctures such as injections and blood draws
  • Wear gloves while doing activities that may cause skin injury (i.e., washing dishes, gardening, working with tools, using chemicals such as detergent)
  • If scratches/punctures to skin occur, wash with soap and water, apply antibiotic ointment, and observe for signs of infection (i.e. redness)
  • If a rash, itching, redness, pain, increased skin temperature, fever or flu-like symptoms occur, contact your physician immediately for early treatment of possible infection

II. Activity / Lifestyle

  • Gradually build up the duration and intensity of any activity or exercise
  • Take frequent rest periods during activity to allow for limb recovery
  • Monitor the extremity during and after activity for any change in size, shape, tissue, texture, soreness, heaviness or firmness
  • Maintain optimal weight

III. Avoid Limb Constriction

  • If possible, avoid having blood pressure taken on the at-risk extremity
  • Wear loose fitting jewelry and clothing

IV. Compression Garments

  • Should be well-fitting
  • Support the at-risk limb with a compression garment for strenuous activity (i.e. weight lifting, prolonged standing, running) except in patients with open wounds or with poor circulation in the at-risk limb
  • Consider wearing a well-fitting compression garment for air travel

V. Extremes of Temperature

  • Avoid exposure to extreme cold, which can be associated with rebound swelling, or chapping of skin
  • Avoid prolonged (greater than 15 minutes) exposure to heat, particularly hot tubs and saunas
  • Avoid placing limb in water temperatures above 102˚ Fahrenheit (38.9˚ Celsius)

VI. Additional Practices Specific to Lower Extremity Lymphedema

  • Avoid prolonged standing, sitting or crossing legs
  • Wear proper, well-fitting footwear and hosiery
  • Support the at-risk limb with a compression garment for strenuous activity except in patients with open wounds or with poor circulation in the at-risk limb

NOTE: Given that there is little evidence-based literature regarding many of these practices, the majority of the recommendations must at this time be based on the knowledge of pathophysiology and decades of clinical experience by experts in the field.