Synopsis
Diagnose chronic lymphatic swelling, exclude dangerous mimics and use decongestive therapy, skin care and cellulitis prevention safely.
- Lymphoedema is protein-rich interstitial swelling from impaired lymph transport; it may be primary or secondary to cancer treatment, nodal disease, infection, obesity, trauma or chronic venous disease.
- Early swelling may pit and improve overnight; later fibrosis, skin thickening and papillomatosis make it firm and non-pitting.
- A positive Stemmer sign supports lymphoedema, but a negative sign does not exclude it.
Key red flags
New warmth, tenderness, erythema/blotchy rash, rapid swelling, fever or flu-like symptoms; systemic toxicity requires emergency care.
Investigation priorities
Confirm distribution, stage severity and provide a reproducible baseline.
Management branches
Persistent limb or midline swelling suggestive of lymphatic failure.
- First: establish onset, cancer/nodal treatment, infection, travel, drugs, venous history and cardiac/renal/liver symptoms; examine both limbs and nodes.
- Next: urgently exclude DVT, cellulitis and malignant/central obstruction when clinical features suggest them.
Volume reduced or stable chronic lymphoedema.
Key medicines
Flucloxacillin500 mg–1 g orally every 6 hours for 14 days for uncomplicated cellulitis in established lymphoedema.
Clarithromycin500 mg orally twice daily for 14 days.