Stages of Lymphedema
STAGE 0 (LATENCY OR SUBCLINICAL) (REVERSIBLE)
A subclinical state where swelling is not evident despite impaired lymph transport. This stage may exist for months or years before edema becomes evident. The patient has reduced transport capacity of their lymphatic system but has no swelling. Most patients are asymptomatic. The patient may have subjective complaints such as heaviness in the limb or mild aching or tightness. There is no swelling or pitting present on exam. At this stage chronic lymphedema is reversible. Without intervention, the patient is at risk to develop chronic lymphedema.
STAGE 1 (MILD) (REVERSIBLE)
With rest and/or elevation, the swollen limb, returns to normal size. Pitting (when pressure is applied to the skin of the swollen area and released an indentation remains) may be present. At this stage chronic lymphedema is reversible. Without intervention, the patient is at risk to develop chronic lymphedema.
Accumulation of protein-rich fluid with limb swelling that does not resolve with limb elevation. The tissue can present with or without pitting, but often in this stage more significant skin changes are present with development of fibrotic tissue and the tissue may have a spongy feel. Most patients don’t experience symptoms until swelling has developed, which can make it too late for prevention. At this stage, lymphedema becomes a chronic condition and is no longer reversible.
The tissue at this stage can be hard (fibrotic). The swelling may be largely irreversible, and the limb can be very large and swollen. Infections are possible at any stage of lymphedema, however, the risk increases as the stages progress. The patient can develop lobules with deep skin creases, which can be problematic hygienically. Skin crevices become prone to fungal infection, skin breakdown, and secondary bacterial infections.
It is important to note that while the above is generally true, there may be differing levels of severity within each stage.
Discuss lymphedema treatment with your physician if you have questions.