Immune cells in peripheral lymph and skin of patients with obstructive lymphedema

Lymph stasis in the extremities caused by interruption of lymphatics or insufficient lymph propulsion is often complicated by recurrent skin infections. To shed further light on this subject, we studied the phenotypical and functional characteristics of cells in peripheral lymph and skin of patients with obstructive lymphedema. Compared with controls, patients with secondary lymphedema displayed a high concentration of lymphocytes and erythrocytes in peripheral lymph, sometimes increased numbers of B cells, increased density of Langerhans cells in the epidermis and occasionally in the skin papillary layer, strong expression of class II antigens on skin endothelial cells and mononuclear infiltration around blood vessels, and margination of granulocytes in skin blood vessels. Reactivity of lymph cells to mitogens was augmented. Taken together these findings indicate that ongoing chronic inflammatory processes persist in skin with lymph stasis, and, moreover, with impaired lymphocyte and Langerhans cell trafficking from skin to regional lymph nodes and inefficient clearance of foreign antigens, these lymphedematous limbs become susceptible to infection.