Stages of Lymphoedema

Whether primary or secondary, lymphoedema is progressive and develops in stages which are categorised according to the severity1. Your healthcare professional will assess, diagnose and categorise your lymphoedema and stage in order to develop a treatment plan that is right for you.


Stage 0 - latent or subclinical stage

Swelling is not visible to the eye or evident using limb measurements. Proteins are accumulating and causing small changes. This stage can last for months, or years, until the swelling becomes apparent but frequently a feeling of heaviness occurs. It is important to monitor any ‘at-risk’ area so that if you notice any changes you can start treatment as soon as possible. The sooner a suitable treatment is started, the better the chances of preventing progression and the easier it is to manage symptoms.

Stage 1 - reversible stage (mild)

Accumulation of protein rich fluid starts to takes place which leads to a swelling. You may notice that your hands or feet look ‘puffy’ and that elevating your limb will help the swelling go away. The oedema is soft and may leave an impression when you push on the skin, which is called “pitting oedema”. You can see an example of this in the images.

Stage 2 – irreversible stage (moderate)

You will notice that limb elevation alone rarely reduces swelling. Pitting may or may not be possible as tissue changes take place (fibrosis tissue). Swelling increases and the limb shape is impacted.

Stage 3 – lymphostatic elephantiasis stage (severe)

Extensive swelling is present. Tissue is hard (fibrotic) and pitting is not possible. Skin changes, such as thickening, hyperpigmentation (change of colour), and warty overgrowths can develop. Large bulges, fat deposits and skin folds are present. The skin becomes vulnerable to deep, hard-to-heal wounds and the danger of infection (e.g. cellulitis) increases.

It is vital that treatment begins as soon as possible to prevent the condition progressing, improve the limb shape and skin condition, reduce the risk of infection and return to a less severe stage.

1 Source: International Society of Lymphology. (2003). The diagnosis and treatment of peripheral lymphedema. Consensus document of the International Society of Lymphology; 36(2): 84-91.