Stages of Lymphedema

Learn about the four stages of lymphedema and how they impact the body in different ways.

Lymphedema is a progressive disease that develops in stages. While all four stages listed below have distinct characteristics, please note that they are all continuous. 

Gradient compression garments are one of the leading and most effective management options for long-term lymphedema treatment.
 

The Four Stages of Lymphedema

Stage 0: Non-Visible or Latency Stage

A subclinical stage where swelling is not evident despite impaired lymph transport. Patients may complain of tightness of the skin or heaviness even though there is no swelling seen. This stage may exist for months or years before edema becomes evident.  

Despite normal limb measurements, latency stage patients with symptoms should seek professional evaluation and often still benefit from management of their lymphedema. Prompt management may decrease risk of their lymphedema worsening.  

Stage 1: Mild or Spontaneously Reversible Stage

Characteristics of stage 1 lymphedema include mild swelling, which typically starts in the furthest part of the limb such as the hand or foot and slowly moves upward as it worsens. This is due to the effects of gravity. The swelling may improve at night or disappears completely, only to come back during the course of the day, as gravity increase lymph pooling in the affected limb. Elevation of the affected limb can help reduce the swelling.  Patients with stage 1 lymphedema should promptly seek treatment from a certified lymphedema therapist to reduce risk of infections and disease progression.  

Use of gradient compression daily can help reduce risk of fluid accumulating. In general, goal of management is to reduce swelling, maximize the function of the remaining lymphatics, and prevent fluid reaccumulation. Because the body has an inflammatory response to the protein-rich lymph fluid, keeping the swelling down can help reduce risk of irreversible changes, as well as decrease risk of infection.

 

Stage 2: Moderate or Spontaneously Irreversible Stage

In Stage 2 the skin takes on a more spongy appearance and "pits" less when you press gently on the skin due to fibrosis and gradual thickening. Deposition of extra fatty tissue below the skin can also occur due to inflammation from the protein-rich lymph fluid in the tissues. At this stage the swelling rarely reduces with just limb elevation. Patients with stage 2 can still have significant reduction of their lymphedema with management. While swelling is spontaneously irreversible, it sometimes can improve over time with daily compression and night time compression as indicated.

Stage 3: Severe or Lymphostatic Elephantiasis Stage

In stage 3 lymphedema the skin typically becomes very hard and scaly and enlarges significantly. There may be lymphorrhea (leaking lymph fluid) from breaks in the skin. Skin lobules are common, and skin folds can become problem areas to keep clean and dry and free of infection. The weight of the limb may contribute to decreased quality of life. Patients with stage 3 lymphedema still benefit from lymphedema management. They often require custom compression garments or an adjustable short-stretch compression garment such as FarrowWrap® to control their symptoms. Patients with stage 3 lymphedema have often gone years or decades without effective management, and it is important to emphasize compliance with management and maintenance compression for them to have the best possible outcome and quality of life.

Managing Lymphedema

Early detection and management are essential in limiting the effects of lymphedema. Once lymphedema is diagnosed, the goal is to delay or event prevent the progression of the disease. JOBST® gradient compression garments help facilitate commitment to compression therapy in all stages of management.