Advertisement

Phlebolymphedema: Disregarded cause of immunocompromised district

      Recurrent lymphangitis, deep trauma, malignancy, and related treatments (ie surgery and radiotherapy) are usually considered the commonest causes of lymphedema. The role of chronic venous disease in this context is often overlooked; yet, all patients with advanced venous disease (stasis dermatitis) have some degree of lymph circulation impairment.
      • Burton C.S.
      • Burkhart C.N.
      • Goldsmith L.A.
      Cutaneous changes in venous and lymphatic insufficiency.
      Venous edema is assumed to be the sole consequence of increased capillary filtration from venous hypertension. Because lymph drainage is the main buffer against the formation of edema, a compensation for the increased lymph load does occur at the beginning. In the long run, however, when the transport capacity is exceeded, the lymphatics fail to keep their buffer function, and interstitial fluid accumulates. This leads to a clinical condition of mixed venous and lymphatic insufficiency that causes a progressive swelling of soft tissues, which is termed phlebolymphedema.
      • Mortimer P.S.
      Disorders of lymphatic vessels.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinics in Dermatology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Burton C.S.
        • Burkhart C.N.
        • Goldsmith L.A.
        Cutaneous changes in venous and lymphatic insufficiency.
        in: Wolff K. Goldsmith L.A. Katz S.I. Gilchrest B.A. Paller A.S. Leffel D.J. 7th ed. Fitzpatrick's dermatology in general medicine. Vol 2. McGraw Hill Medical, New York2008: 1679-1686
        • Mortimer P.S.
        Disorders of lymphatic vessels.
        in: Burns T. Breathnach S. Cox N. Griffiths C. 8th ed. Rook's textbook of dermatology. Vol 3. Wiley-Blackwell, Oxford2010
        • Bollinger A.
        • Isrensing G.
        • Franzeck U.
        Lymphatic microangiopathy: a complication of chronic venous insufficiency.
        Lymphology. 1982; 15: 60-65
        • Brodell J.D.
        • Brodell R.T.
        Recurrent lymphangitic cellulitis syndrome.
        Contemp Orthop. 1992; 25: 461-468
        • Karakaş M.
        • Baba M.
        • Aksungur V.L.
        Manifestation of cellulitis after saphenous venectomy for coronary bypass surgery.
        J Eur Acad Dermatol Venereol. 2002; 16: 438-440
        • Ruocco V.
        • Brunetti G.
        • Puca R.V.
        • Ruocco E.
        The immunocompromised district: a unifying concept for lymphoedematous, herpes-infected and otherwise damaged sites.
        J Eur Acad Dermatol Venereol. 2009; 23: 1364-1373
        • Ruocco V.
        • Ruocco E.
        • Brunetti G.
        • Wolf R.
        Achilles’ heel in dermatology (Letter to the Editor).
        J Eur Acad Dermatol Venereol. 2010; 24: 1119-1120
        • Ruocco V.
        • Ruocco E.
        • Brunetti G.
        • Sangiuliano S.
        • Wolf R.
        Opportunistic localization of skin lesions on vulnerable areas.
        Clin Dermatol. 2011; 29: 483-488
        • Smith J.
        • Mello L.F.
        Nogueira Neto NC, et al. Malignancy in chronic ulcers and scars of the leg (Marjolin's ulcer): a study of 21 patients.
        Skeletal Radiol. 2001; 30: 331-337
        • Cendras J.
        • Sparsa A.
        • Bedane C.
        • Delage M.
        • Touati M.
        • Bonnetblanc J.M.
        Lymphome B primitif à grandes cellules CD20-, CD79a+ apparu sur un ulcère veinenx chronique de jambe.
        Ann Dermatol Venereol. 2007; 134: 357-361
        • Mortimer P.S.
        • Burnand K.G.
        • Neumann H.A.M.
        Diseases of the veins and arteries: leg ulcers.
        in: 8th ed. Rook's textbook of dermatology. Vol 3. Wiley-Blackwell, Oxford2010: 1-58
        • Borgia F.
        • Cannavò S.P.
        • Guarneri F.
        • Manfrè C.
        • Vaccaro M.
        Isomorphic response after saphenectomy in a patient with granuloma annulare.
        J Am Acad Dermatol. 2004; 50: S31-S33