Videodermatoscopy (VD) is a non-invasive technique in whichskin is observed in vivo by a video camera equipped with lenses that allow magnifications ranging from 4x to 1000x. The images obtained are visualized on a high definition monitor and may be stored on a personal computer, in order to identify and compare changes over time [1].
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 [2].
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
The 7 stages of classification as given below are clinically based [2]:
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
Stage 2: Swelling is not reversible 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.
These skin changes are a result of stagnation of lymph, inflammation leading to fibrosis. This also leads to inability to care for the affected limb leading to a vicious cycle of infection, inflammation and further deterioration of the skin condition.
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.