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Management
Many surgeons are content to diagnose mild lymphoedema from the history and physical findings without investigating the patient further. This clinical diagnosis can however be incorrect and isotope lymphography should be obtained if possible. This not only provides a firm diagnosis, but also allows an assessment to be made of prognosis and of possible problems that may be present in the contralateral limb. Young women with mild lymphoedema of gradual onset usually have distal lymphatic hypoplasia: there is prolongation of the time taken for the isotope to reach the groin nodes, but normal onward passage. This type of lymphoedema is often inherited (at least 30 per cent), and rarely becomes severe or extends above the knee. It is often bilateral but one limb may be affected several years before the other. Rarely, the upper limbs are also involved.
Physical methods
Patients with this condition rarely require surgery. They should be given advice on limb elevation, especially in the evenings and at night, and some patients benefit from regular massage or mechanical compression combined with wearing of graduated elastic compression stockings. Pneumatic massaging devices are obtainable, and sequential segmental machines such as the lymphopress  are probably more effective than single chamber boots. These may be worn in the evenings or in bed at night, although they may interfere with sleep. Correctly graduated strong compression stockings 50 mmHg at the ankle, decreasing up the limb) only need to reach below knee level if the lymphoedema is distal in distribution. Elastic compression stockings do not cure lymphoedema, but they reduce fluid accumulation and often produce considerable symptomatic relief. They are poorly tolerated in warm climates and young women tend to be conscious of their appearance. Weight reduction is often beneficial and physical exercise is never harmful; concentrated compression therapy and massage may also reduce the size of lymphoedematous limbs.
Drug therapy
Diuretics are of little value in removing fluid from the whole body and may cause a number of problems when used unnecessarily for many years. Paroven (hydroxyrutosides) has some anecdotal support, as do the coumadins, but these compounds have not yet been tested in a well controlled clinical trial.
Antibiotics (flucloxacillin, amoxycillin, or one of the cephalosporins) should be prescribed for cellulitis and may be given in a low dose prophylactically if patients are troubled by repeated attacks. Athletes' foot must be eradicated by appropriate antifungal medication and creams. Careful attention to drying and powdering of the feet prevents infection and avoids an important portal of entry for virulent bacteria.
Surgery
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