Stages of Lymphedema

There are four primary stages of lymphedema that each impact the body in different ways, and can be categorized according to severity. Lymphedema, if untreated, tends to progress over time and can advance in stages. There is variable penetration and some patients will progress quicker and more than others. Occasionally, patients may go decades and not progress.

Stage 0 - Latency or Subclinical Stage

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. The patient is at risk to develop lymphedema.

Stage 1- Mild Stage

Early accumulation of protein-rich fluid that subsides with limb elevation. Pitting may occur. The skin is typically soft with no dermal fibrosis. There may be edema present which pits. This is often called the Reversible stage since the edema can reverse and go away with elevation or compression.

Stage 2 - Moderate Stage

Accumulation of protein-rich fluid with limb swelling that does not resolve with limb elevation. There is early dermal fibrosis starting to develop. The limb may not longer pit on exam. This is sometimes called Spontaneously Irreversible stage since it does not reverse with compression. With prolonged treatment and compliance dermal fibrosis can improve and reverse.

Stage 3 - Lymphostatic Elephantiasis (Severe Stage)

On exam there is swelling. Pitting can be absent. Trophic skin changes such as acanthosis, fat deposits, papillomatosis, and hyperkeratosis develop. 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.

stages of lymphedema