The Australasian Lymphology Association (ALA), the peak professional organisation promoting best practice in lymphoedema management, research and education, is committed to promoting the development of lymphology in Australasia to those at risk of developing the disorder and to those able to diagnose lymphoedema – medical practitioners.
With early intervention being the primary means of limiting the impact lymphoedema has on patients, a key aim of the month-long awareness campaign is to inform medical practitioners and those in the high risk groups of the early signs and symptoms to limit the progression of the disorder.
Lymphoedema is a chronic accumulation of protein rich fluid in any part of the body (limbs, trunk, breast, genitalia and head/neck). It is due to an imbalance between interstitial fluid production and transport of lymph fluids - A life threatening illness is replaced with a life-long distressing and debilitating condition.
Any major damage to the lymphatic system causes a life-long risk of lymphoedema.
Primary – due to a congenital malformation of the lymphatics
Secondary – due to damage to lymph nodes (surgery/radiation), infection or trauma
Mixed lymphoedema – combined with venous disease, immobility or lipoedema (abnormal deposition of fat tissue)
Any patient who has been treated for cancer where the lymph nodes have been removed or damaged during surgery and/or radiation
Cancer patients who have been identified as being most at risk include those treated for breast, melanoma, gynecological and prostate cancer.
The stage, location and severity of lymphoedema, together with the individual circumstances of the patient, play a vital role in managing the condition. Key risk factors include:
the extent of surgery, lymph node dissection and radiation treatment
wounds, trauma, infection (cellulitis & fungal infections)
increased body mass index (BMI) and immobility.
Many conditions may cause similar symptoms however, if early warning signs are experienced, other possible causes of the swelling should be excluded.
Early warning signs of lymphoedema can be intermittent and may include:
transient swelling of a limb or other region of the body after surgery, even if intermittent
infection (due to lymph stasis) is often the first sign of a problem
feelings of aching, heaviness, stiffness in the affected body part
limitation of movement
tightness or temperature changes to areas of the body clothing, jewellery or shoes may feel tighter
swelling may be aggravated by heat, overuse, sustained positions and prolonged inactivity and more obvious at the end of the day
permanent swelling of more than 3 months (pitting in early stages)
usually asymmetrical, especially when affecting the upper limb
Stemmer’s sign positive (unable to pinch the skin at the base of the second toe).
Clinical diagnosis. Need to exclude recurrence of malignancy, DVT, venous insufficiency, heart/renal/hepatic failure and myxoedema
Lymphoedema is a chronic condition that qualifies the patient for a Chronic Disease Management Plan
If diagnosis of lymphoedema is confirmed, referral to an ALA Accredited Practitioner is recommended and can be found in your region through the National Lymphoedema Practitioners Register (NLPR) - Find a practitioner
Complex Lymphoedema Therapy (CLT) or Complex Decongestive Therapy (CDT) is the treatment of choice in Australia consisting of:
Skin care
Exercise
Manual Lymphatic Drainage
Compression Therapy
NOTE: Information on lymphoedema management is available here.
Pathogen is usually Strep. pyogenes - Phenoxymethylpenicillin 500mg q6h for minimum of 14 days
Evidence of Staph. Aureus (folliculitis, pus or dermatitis) - Flucloxacillin 500mg PO q6h
Cephalexin 500mg q6h for penicillin hypersenstivity, or Clindamycin 450mg q8h for penicillin allergy
May need antibiotics for up to 1-2 months for complete resolution
Antibiotic prophylaxis if 2 or more episodes of cellulitis in 12 months
Please see Managing Cellulitis Consensus Guideline for further details.
The Australasian Lymphology Association (ALA) is committed to promoting the development of lymphology in Australasia. The Association will strive to improve the management of those with, or at risk of developing lymphoedema and enhance communication between health professionals, educators, relevant authorities and government in regard to oedemas and lymphoedema.
