Lymphedema, accumulation of fluid in the extremities, results in swelling, pain, and tightness of the affected limb. Lymphatics that are malformed, or damaged or destroyed by surgery or radiation, cannot absorb extracellular fluid, which stagnates, providing decreased resistance to infections and promoting skin damage and fibrosis of the underlying tissues. Along with conventional therapies aimed at preventing and minimizing this chronic condition, experimental therapies described may prove effective following further investigational studies.
Infrared therapy
Low-level infrared light at a wavelength of 670 nanometers is considered an experimental therapy with poorly reproducible evidence of efficacy in lymphedema. Red light is thought to help augment the local immune system in lymphedema fluid by activating and recruiting cells responsible for breaking down protein molecules and destroying bacteria. These same cells may assist in degrading the fibrous tissue present, as well. The anticipated result is decreased skin infections, decreased fluid volume, and decreased fibrous tissue, although research data has been mixed to this end. More controversial is the suggestion that infrared therapy promotes new growth of lymphatic channels.
Drug therapy
As the proteinaceous fluid is thick and the mechanism for transporting it out of the tissues is damaged, usual diuretic medications that affect the transport of fluid in and out of the blood vessels and kidneys have little effect. Benzopyrones, which comprise the plant-based medications flavonoids and coumarin, not to be confused with Coumadin, a blood thinner, rather than affecting fluid shifts in the body directly, induce blood cells to break down proteins into smaller molecules more easily resorbed. The proteins are small enough to be transported by the weakened lymphatic channels, drawing fluid into the lymphatics and out of the tissue. European countries and India report reduction in fluid volume and swelling in patients undergoing this treatment; however, due to FDA regulations, these drugs are not available at this time in the United States.
Dietary therapy
The accumulation of the protein-rich fluid also results in proliferation of fat cells. One of the therapeutic modalities includes weight loss with concomitant increased ingestion of fresh fruit and vegetables including pineapple and grapes. Raw pineapples rich in bromelain and grapes rich in oligomeric proanthocyanidins purportedly promote a natural anti-inflammatory response as well as fluid shift, or diuresis. Unfortunately, data suggesting a therapeutic amount or frequency of ingestion is not available.
Herbal Therapy
In general, herbal medications are just that, medications, their use requiring caution and guidance from a medical professional to prevent potentially harmful drug interactions, and monitoring for drug toxicity. Herbs such as butcher's broom, ginger tea, and sweet clover reportedly increase lymphatic circulation and decrease inflammation in lymphedematous limbs. Aesculin, also known as horse chestnut, may decrease the amount of fluid escaping blood vessels into the soft tissues, thus reducing the fluid volume of the limb.
