Lymphedema is characterized by a chronic increase in the size of a limb, linked to an accumulation of lymphatic fluid. Swelling occurs when the lymph vessels no longer drain lymph effectively enough, which then accumulates in the tissues under the skin. Lymphedema can cause infectious, cutaneous and rheumatic complications. There is no cure for lymphedema, but decongestant physiotherapy can slow its development. The prevalence of lymphedema is thought to be greater than 100 people per 100. (000)

The extent and location of lymphedema are variable. It is diagnosed clinically when the perimeter of the affected limb is at least 2 cm greater than that of the healthy limb. It most often occurs on an arm or a leg, but the swelling can affect other parts of the body: the face, neck, trunk, genitals. It causes a feeling of heaviness and tension, sometimes also pain. Lymphedema causes thickening and fibrosis of the skin evident in Stemmer’s sign, the inability to wrinkle the skin of the 2nd toe.

Two very distinct causes are responsible for the appearance of lymphedema:

When a malformation of the lymphatic system of genetic origin is the cause, it is called primary lymphedema. The genetic mutation is most often spontaneous but, in rarer cases, lymphedema is congenital and affects several people from the same family. Primary lymphedema affects 1 in 10 people and occurs most often during puberty. (000)

Secondary lymphedema is an acquired change in the lymphatic system. It can occur following surgery (removal of varicose veins or lymph nodes, for example), treatment of a tumor (such as radiation therapy to treat breast cancer), an accident, or an infection.

Lymphedema is clearly distinguished 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 the tissues (connective and adipose), while the second consists mainly of water.

Primary lymphedema (of genetic origin) occurs significantly more frequently in women. We observe in them a peak incidence at puberty. On the other hand, the relationship is established between overweight and the frequency of occurrence of secondary lymphedema.

To date, there is no curative treatment 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 through 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 reduction of lymphedema by massage and compression, the application of elastic compression prevents the lymph from accumulating again;
• Specific physical exercises are also recommended by the physiotherapist.

Left untreated, lymphedema progresses chronically and can cause complications such as skin infections. It can significantly alter the quality of life of the person affected by causing pain, disability and have psychological consequences.