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Stages of lymphedema

Lymphedema is classified into four stages (0-3) as defined by the International Society of Lymphology in 2016, each affecting your body in distinct ways.

Without treatment, lymphedema is a progressive disease. The four stages of lymphedema are graded according to their severity and run from not visible (stage 0) to severe (stage 3).

Your Healthcare Professional will assess, diagnose and probably categorize the stage of your lymphedema – and together, you’ll build a treatment plan that’s right for you. The earlier you start treatment, the better your chances of preventing the progression and improving the symptoms of your lymphedema.

Legs with no visible swelling.

Stage 0

Latent or subclinical stage

In stage 0, the edema is not visible or even evident using limb measurements despite impaired lymph transport. This stage may exist for months or years before you notice any swelling. Therefore, it’s important to keep an eye on the at-risk area. If you observe any changes, consult your Healthcare Professional to start treatment immediately.

Legs showing slight swelling around the ankles.

Stage 1

Mild stage

In stage 1, fluid starts to collect in the affected area and causes swelling. You may notice that the affected area looks puffy. Elevating your limb will help the swelling to go away. The edema is soft and may leave an impression when you push on the skin, called ‘pitting edema’.

Legs with moderate swelling, visible on the lower legs and ankles.

Stage 2

Moderate stage

With stage 2, you will notice that limb elevation alone rarely reduces swelling. Pitting is manifest. Later in stage 2 the limb may not pit, as excess subcutaneous fat forms, and tissue fibrosis (hardening of the skin) develops. Swelling increases.

Legs with severe swelling, pronounced skin folds, and deformity.

Stage 3

Severe stage

In stage 3, there is extensive swelling present. The tissue is fibrotic (hard) and pitting is no longer possible. Skin changes, such as thickening, hyperpigmentation (change of color), increased skin folds, fat deposits, and wart-like growths, can develop. The skin becomes susceptible to deep, poorly healing wounds and is in danger of infection.

Early treatment can support the proper management of your symptoms. It prevents your lymphedema from progressing, improves the limb shape and skin condition, and reduces the risk of infection. Your condition may also return to a less severe stage.

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