[Skin alterations and tissue reactions in lymphedema]

Chronic lymphedema is an inflammatory disease that in addition to a typical volume increase, also leads to changes in the skin and tissues. Cysts and fistulas are a direct consequence of the increased pressure in the lymphatic vessels, while pachydermia and papillomatosis are signs of the inflammatory process in the tissues. This inflammation causes, among other things, the release of various interleukins through the activation of hypoxia-inducible factor (HIF) from lymph endothelial cells, macrophages, Th1, Th2 and Th17 cells, leading to fibroadipose tissue transformation and a resulting reduction in immune function. To avoid these consequences, treatment of the inflammatory response should be considered in addition to complex decongestive therapy (CDT), as is the case with other fibrosing skin diseases.