Journal of Clinical Dermatology & Therapy Category: Clinical Type: Case Study
Video Dermatoscopy in Lymphedema An Additional Tool
- Chirra Likhitha Reddy1, Ravi Kumar Chittoria1*, Abhinav Aggarwal1, Saurabh Gupta1, Padma Lakshmi Bharathi Mohan1, Shijina K1, Imran Pathan1
- 1 Department Of Plastic Surgery, Jawaharlal Institute Of Postgraduate Medical Education And Research (JIPMER), Pondicherry, India
*Corresponding Author:Ravi Kumar Chittoria
Department Of Plastic Surgery, Jawaharlal Institute Of Postgraduate Medical Education And Research (JIPMER), Pondicherry, India
Received Date: Oct 29, 2019 Accepted Date: Nov 11, 2019 Published Date: Nov 18, 2019
Lymphedema (primary & secondary) is associated with various secondary skin changes ranging from reversible pitting edema to mossy foot. These skin changes are classified by WHO into 7 stages .
According to the Fifth WHO Expert Committee on Filariasis, lymphoedema can be classified as follows:
- Grade I lymphoedema: mostly pitting edema; spontaneously reversible on elevation
- Grade II lymphoedema: mostly non-pitting edema; not spontaneously reversible on elevation
- Grade III lymphoedema (elephantiasis): a gross increase in volume in a grade II lymphoedema, with dermatosclerosis and papillomatous lesions
Stage 1: The feature of stage 1 lymphoedema is:
- Swelling is reversible overnight
- In stage 1 lymphoedema, the swelling increases during the day and disappears overnight
The main difference between stage 2 lymphoedema and stage 1 is that the swelling does not disappear without lymphoedema management.
Stage 3: Swelling is not reversible overnight.The principal feature of stage 3 lymphoedema is the presence of one or more shallow skin folds
Stage 4: Swelling is not reversible overnight.
The main feature of stage 4 lymphoedema is the presence of knobs lumps, lumps, or protrusions on the skin
Stage 5: Swelling is not reversible overnight.
The presence of one or more deep skin folds is the main feature of stage 5 lymphoedema
Stage 6: Swelling is not reversible overnight. On the surface of the foot (especially the toes), very small elongated or rounded small knobs can be clustered together, giving rise to the peculiar appearance of “mossy foot”
Patients with stage 6 lymphoedema) have acute attacks. Almost all these patients have entry lesions between the toes and bad odour. Wounds in the skin are frequently present.
Stage 7: The features of stage 7 lymphoedema are:
- Swelling is not reversible overnight. The patient is unable to adequately or independently perform routine daily activities such as walking, bathing, cooking, etc.
Emphasis on management of lymphedema is in the treatment and prevention of infection of the limb, the main source of which is the fissures in the skin through which ascending lymphangitis is noticed.
Even though most of the skin changes are visible through the naked eye, videodermatoscopy may help for accurate assessment of the skin changes and possible sites of future infection may be identified earlier due to higher magnification, thus leading to better management of the patient.
MATERIALS AND METHODS
Videodermatoscopy was done using Aram Huvis® videodermatoscope with 1x, 60x (Figure 2), 200x (Figure 3), 1000x (Figure 4) with Skin XP Pro software system.
In lymphedema, the videodermatoscope not only helps in recording the progress of the skin changes with serial images, it also helps in identifying potential sites of entry of infection by accurately identifying the deep fissures , areas of dryness, or fungal infection which can then be treated appropriately. Also, it is valuable in identifying a possible source of infection which will help in preventing serious infections and the vicious cycle of skin thickening and more fissures leading to repeated infections.
It also helps in identifying and diagnosing the dreaded complication of lymphedema i.e., lymphangiosarcoma .
- Micali G, Lacarrubba F (2003) Possible applications of videodermatoscopy beyond pigmented lesions. International journal of dermatology. 42: 430-433.
- Dreyer G, Addiss D, Bettinger J, Dreyer P, Norões J, wt al. (2001) Lymphoedema staff manual: treatment and prevention of problems associated with lymphatic filariasis. In Lymphoedema staff manual: treatment and prevention of problems associated with lymphatic filariasis, WHO, Geneva, Switzerland.
- Micali G, Lacarrubba F (2010) Dermatoscopy in clinical practice: Beyond pigmented lesions. CRC Press, Florida, USA.
- Le Fourn E, Duhard E, Tauveron V, Maruani A, Samimi M, et al. (2011) Changes in the nail unit in patients with secondary lymphoedema identified using clinical, dermoscopic and ultrasound examination. Br J Dermatol 164: 765-770.
- Kelati A, Debagh F, Mernissi FZ (2018) Dermoscopy in a lymphangiosarcoma of Stewart–Treves syndrome. Breast Cancer Management 7: 12.
Citation:Reddy CL, Chittoria RK, Aggarwal A, Gupta S, Mohan PLBM (2019) Video dermatoscopy in Lymphedema - An Additional Tool. J Clin Dermatol Ther 5: 040.
Copyright: © 2019 Chirra Likhitha Reddy, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.