The early stages of lymphedema are characterized by soft skin and swelling with an impression. Initially the swelling may not be continuous and may be followed by a feeling of heaviness in the limb. At this stage the lymphedema responds well to treatment. If left untreated, the increased pressure from the fluid build-up causes the lymphatic vessels to dilate which allows the lymph to return to the tissues. This can result in pain, redness, heat and swelling, as well as the skin changing from soft to hard and inelastic. At this stage lymphedema does not respond well to conservative treatment. Early lymphedema can last for several years, but will eventually worsen if not treated properly and become a chronic condition.
As fluid accumulates in the interstitial space, massive swelling of the lymphatics in the limb is created. At this point the lymphedema is described as "lymphedema with impression" which means that if we press the skin with a finger, the impression will remain for a few seconds. As the condition progresses, the accumulation of proteins and fluid causes an inflammatory reaction and production of fibrous tissue (hard fibrous tissue), resulting in fibrosis and hardening of the skin. Finger pressure on the member no longer leaves an impression, meaning the tissue beneath the skin is no longer elastic.
The skin hardens and takes on an orange appearance due to congestion. It can lose its continuity in some places and there is a flow of lymph. Aggravation of lymphedema can also be due to repeated inflammations caused by bacteria entering through wounds in the skin.
As lymphedema worsens, it has an increasing impact on the patient's daily life. Joint range of motion is reduced, there is pain, skin changes and a predisposition to infections. If not treated properly, lymphedema in some cases results in: