Dr. Mortimer’s response:

No, there is no evidence that laser treatment can cause lymphoedema of the face.

It will be limited to the sites where the worm resides. That is usually one limb but the worm can block extensive local sites including pelvis and so genitalia (hydrocele), gut lymphatics (chylous disease) and even an arm.

Treatment of Filariasis should be through a hospital for tropical diseases. If you are in the UK then this would be:
The Hospital for Tropical Diseases (HTD) is a member of the University College London Hospitals, NHS Trust.

2nd Floor
Mortimer Market
Capper Street
Tottenham Court Road
London WC1E 6JB
Telephone: 020 3447 5959

If veins are weak eg varicose veins, the lymph vessels are often also weak. Treatment of varicose veins eg radiofrequency ablation, may damage vulnerable lymph vessels. Cellulitis often results from a damaged lymph circulation. Low dose penicillin every day and lymphoedema treatment are the recommendations

Interesting observation
I have not come across that before and there is nothing to my knowledge in the medical literature to suggest a benefit from chemo on lipoedema.
My best guess is that the steroids administered with the chemo temporarily helped

I am not sure i fully understand the question but there is anecdotal evidence that psoriatic arthritis can be associated with lymphoedema.

I believe psoriatic arthritis causes lymphoedema. To treat the lymphoedema in these circumstances, the priority must be to treat the psoriatic arthritis in any way possible; that could be methotrexate or biologics.
Once inflammation from the arthritis is under control then one can address the lymphoedema for which there is no drug treatment

The duration of prophylactic antibiotics is a matter of judgement by the doctor. If a patient of mine has successful prophylaxis with penicillin (phenoxymethylpenicillin) for 2 years but then relapses with cellulitis when prophylaxis stopped I would encourage lifelong penicillin. I am not so comfortable prescribing other prophylactic antibiotics for long periods. The safety profile for simple penicillin is much better. Most people who think they are allergic to penicillin turn out not to be when tested

Depends entirely what the sore is
Lymphoedema alone does not cause sores
Sorry, but impossible to answer without more information and a proper consultation is needed

It could do, but the likelihood is that the injection will not cause a problem. It is a difficult risk/benefit calculation. I would try all other conservative treatments first but if the stenosing tenosynovitis demands the injection then so be it. Ask the surgeon if he/she understands the risks.

The recommendation is to wear light compression as soon as it is comfortable to do so and perform light movements. The rationale for this is to improve lymph drainage and help clear the infection. Clearly this would only be possible when the infection has peaked and pain is beginning to ease.  There is no scientific proof that this approach works but it makes sense.

Neither lymphoedema nor lipoedema cause leg ulceration. Underlying varicose veins are the commonest cause but your circumstances sound more complicated. Further investigation is required before the correct treatment can be given. Healing of the ulcers will be totally dependent on finding the cause

Thank you for this question
I presume you are asking the best method for mapping lymphatic pathways/vessels/channels/drainage routes. My answer would be ICG lymphography although often a combination of imaging methods can provide the best picture of drainage routes (ICG lymphography, lymphoscintigraphy and MR lymphangiography with contrast)
Lymphoscintigraphy is available on the NHS and ICG lymphography at the Royal Marsden Hospital

I see a lot of Dercum’s but I am afraid to say there is no satisfactory treatment.
The lumps are usually painful angiolipomas and there are usually too may to remove. Treatment then becomes symptomatic only

Dear Lucy
Best not conduct your personal care through this channel
Can you contact my office please and we will sort?
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Please contact the Lymphoedema Support Network which is the patient helpline for lymphoedema in the UK. They can advise you.
There are centres of lymphoedema expertise in the uk but few and far between
Your oncology specialist can refer on to a lymphoedema therapist as recommended by the LSN

https://www.lymphoedema.org/

020 7351 4480

Not unless
1. the patient is overweight and a weight reducing diet is indicated because any excess weight undermines lymphatic function
2. the patient suffers with intestinal lymphangiectasia which results in poor absorption of fat in which case a low fat diet is indicated

I am afraid it is impossible, and indeed professionally unwise, to advise without consultation. All I can say is that excess weight seriously compromises the lymph system and weight loss is mandatory in such circumstances

I am afraid it is not possible to answer this question without more information and even then a full in person consultation would probably be needed to make a proper diagnosis and provide the correct treatment

In theory yes. Lymphoedema can be caused by bulk disease from lymphoma overwhelming lymph nodes
or
treatment of that lymphoma from radiotherapy and possibly chemotherapy.

No, that is not true

Dear friend,
No, it would not be possible to diagnose a syndrome from the lymphoscintigraphy results.
Diagnosing a syndrome involves obtaining clear details of the personal history/story and then examining the patient to make the diagnosis. It is a very clinical process.

There are more than 20 types of primary lymphoedema. We know the gene cause for approximately 25% of all primary lymphoedemas. The scientific reference is:

The St George’s Classification Algorithm of Primary Lymphatic Anomalies.
Gordon K, Mortimer PS, van Zanten M, Jeffery S, Ostergaard P, Mansour S.
Lymphat Res Biol. 2021 Feb;19(1):25-30. doi: 10.1089/lrb.2020.0104. Epub 2021 Jan 4.

For an accurate diagnosis you would have to be seen, a careful history taken and a full examination performed, with or without further investigation, for a phenotype (category) to be declared.
If you live in the UK then you would need to be referred to St George’s Hospital in London which is the national centre for primary lymphoedema. Please let LE&RN; know where you live and we will try and connect you to an expert.

Dear Mr Evans,
I don’t know where you live but if in the UK I suggest you contact the Lymphoedema Support Network for advice. They will probably direct you to the national centre for primary lymphoedema at St George’s Hospital in London.
I am speaking on Primary Lymphoedema this coming Thursday via the LE&RN; online symposium. Do log in

Miss Caty Milroy at Parkside hospital, Wimbledon is fully trained in the Brorson technique

Intense research is ongoing to find a biomarker for lymphoedema. Blood tests are not routinely available and it may still be some time before these blood tests for proteins that Prof Rockson has discovered are validated.
Currently the best way of confirming lymphoedema is through lymphoscintigraphy, a nuclear medicine test which is readily available in most hospitals

Whenever a germ (virus or bacteria) enters our mouth or nose it lands on the lining inside. It is then taken up by our our lymphatic system and transported to lymphoid organs such as lymph glands and tonsils in order to generate an immune response. That process produces many more immune cells which inevitably swells the lymphoid organ and can result in cytokine production which can make you feel unwell. Therefore what you are encountering is part and parcel of our immune defences

Clearly, the surgery disturbed your lymph drainage from your gut. It might be there was a problem before but the surgery acted as a trigger to expose the lymphatic weakness.
At St George’s Hopital, London, SW17 we do intranodal lymphography and can sometimes plug the leak
If your doctors contact/refer to me Professor Mortimer at
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we might be able to help

Cancer cells travel and spread preferentially via lymphatic vessels. If the cancer cells overwhelm the lymphatic vessels, they block the flow of lymph to cause lymphoedema but they also incite a fibrosis in the affected tissue to cause skin hardening. Lymph under pressure (from the blockage) also leads to tightness and thickening but explains why lymph tries to escape (and leak).
The only satisfactory treatment is to get rid of the cancer cells somehow

I am afraid there is no easy answer as there could be many possible explanations for extensive lymphoedema including heart failure. Leaking lymph fluid will be because of the congestion of the fluid within the skin and surrounding tissues. Wounds just allow the fluid to escape more easily. Your mother needs a full medical assessment to answer these questions.
Sorry not to be more help

Thank you for your enquiry
No, itching is not a symptom of lymphoedema.
I would need to know more to answer but this forum cannot be used for consultation

Difficult to advise without consultation
In principle you should avoid any trigger factors such as athlete’s foot but in about one third of patients prophylactic antibiotics do fail
As far as we know the bacteria do not become resistant and I cannot incriminate sertraline.
I suggest an increase in dosage to 500mgs twice daily which is very safe.

Thank you for this enquiry
As I hope you know, cellulitis is a common complication of any lymphoedema.
National guidelines in the UK, available through the Lymphoedema Support Network’ website, recommend preventative antibiotics for more than 2 attacks of cellulitis in any 12 month period.
Cellulitis can cause peeling of the skin during recovery of an attack but should then resolve. If peeling is ongoing a dermatology opinion is indicated as there may be a skin condition that needs addressing

Elephantiasis simply means lymphoedema but is a term used in tropical climates.
I am assuming you are referring to an inherited form of lymphoedema.
If you are in the UK then please contact the Lymphoedema Support network for more information
http://www.lymphoedema.org

You almost certainly have in inherited primary lymphoedema for which gene testing is now possible,
Any increase in swelling with pain should make one think of infection
(Please refer to guidelines on cellulitis: http://www.lymphoedema.org/cellulitis)
I suggest you see somebody familiar with cellulitis in lymphoedema

The diagnosis does sound like lipoedema but it can be difficult to distinguish from lymphoedema although lymphoedema is not usually as painful. It is important to undertake quantitative lymphoscintigraphy as this investigation can be helpful in distinguishing lipoedema form lymphoedema. If this is not possible I suggest consulting a MLD or Lymphoedema therapist in your area as they can usually differentiate one from the other. Alternatively see your GP and ensure they have read the Royal College of GPs details on lipoedema

There remains, sadly, little knowledge amongst the medical profession of Lipoedema (Lipedema)
There is a learning module for GPs on the Royal College of General Practitioners website. You should point that out to your GP as well as the patient’s organisation Lipedema UK (http://www.lipoedema.co.uk)
You should go back to your GP with this information and/or access a local Lymphoedema or MLD therapist (via the Lymphoedema Support Network’s helpline) who will be able to provide help for you.
(assuming you live in the UK)

The dermis is essentially the skin capped with a layer of scale (keratin) known as the epidermis (the outer covering to the dermis).
The subcutaneous tissues consist mainly of fat and reside beneath the skin, hence the name sub (beneath) cutaneous (skin).
In lymphoedema both become thickened. Thickening (increase) of subcutaneous tissues will mean an increase in fat so obesity as well as lymphoedema can do that.

Skin color is largely determined by melanin e.g. black skin has a lot of melanin and skin tanning increases melanin to increase pigmentation. Complete loss of melanin occurs in vitiligo such as Michael Jackson had. I am unaware of lymphedema affecting melanin.
Also influencing skin color is haemoglobin in blood. Lymphedema thickens the skin making it more difficult to see blood through the thickened skin. Therefore lymphedema skin might be paler at sites of worse swelling.
Past sun damage confuses the situation and will contribute to changes in skin color on the outside of the forearm and back of hand but not the inside of the forearm where sun damage is minimal

Sorry but do not understand
LUE=Life, the Universe and Everything?
LE means LUPUS to me
PCP=personal centred plan?

No, patients with secondary lymphoedema should not be considered an ‘at risk’ group. The danger from Covid-19, as far as I know, is pneumonia/lower respiratory tract infection. Secondary lymphoedema patients are no more at risk of respiratory tract problems than the general population providing they do not have lymph problems relating to the respiratory tract.

I am not an expert on breast oedema, as there isn’t usually a surgical solution. I would suggest routing your question to Prof Mortimer.

Long haul flights are a challenge for anybody with lymphoedema but no reason not to go. Swelling will probably increase temporarily. To minimise this, wear compression garments, keep moving as much as possible and avoid alcohol. On arrival, if swelling has increased, spend time getting legs to recover by walking in a swimming pool followed by elevation.
Go for it!

This is one area of lymphatics in which I am not so knowledgeable. This is because lymphatic malformations of the tongue (lymphangioma) are generally seen by oral surgeons/paediatric surgeons not by us. Nevertheless the published medical literature suggests that sirolimus may be effective. There is a risk from the immunosuppression from the sirolimus but on balance of benefit/risk definitely worth trying.

A strenuous 2 hour walk could cause lymphedema to get worse because the demands on muscles will result in more blood, and therefore fluid, in the muscles. This extra fluid will have to be drained by the lymphatics. Compression plus exercise should avoid problems because of greater encouragement for lymph drainage.

I have seen chunks of calcium extruded form leg ulcers. These chunks of calcium represent phleboliths (small clots in superficial veins)which have become calcified and then the body wants to get rid of them so they are pushed out of the skin mainly through a wound but can break through intact skin. I have no other explanation

Yes, it is perfectly possible that bacteria from one attack of cellulitis in lymphoedema are not fully eradicated. In my view that is why an attack can re-emerge in a matter of weeks after a previous attack. I believe it is related to the altered immunity that exists in tissues affected by lymphoedema.
Unfortunately there are no tests to prove this (yet)
You need to see a specialist who is experienced in lymphoedema.
Please see http://www.lymphoedema.org and click on cellulitis on the lymphoedema support network webpage

Whether obesity actually causes lymphedema is unclear but it can certainly lead to lymphedema, make it worse, and make it more resistant to treatment. Furthermore, losing weight in anybody with lymphedema who is obese, can improve the swelling substantially.

Calcium channel blockers paralyse lymphatic vessel pumping but also generate extra lymph production by causing relaxation of peripheral blood vessels. The effect is much greater in the legs than the arms due to the greater effect of gravity in the legs. Amlodipine is one of the worst offenders and can cause oedema in 50% of patients receiving the drug. Lercandipine causes least likelihood of oedema but my advice to anybody with lymphoedema is to avoid CCBs altogether as there are many alternatives for BP treatment.

Dr. Mortimer’s Response:

Weeping Lymphoedema wounds represent lymph leaking through broken skin. The underlying physiology needs to be understood and addressed first. For example high pressure within the veins will increase lymph production and pressure of lymph in tissues. The most important treatment is compression. The dressing is relatively unimportant so a simple non-adherent dressing usually suffices.

Dr. Mortimer’s Response:

Manuka honey, eliminates bacteria, resolves chronic inflammation, and promotes faster wound healing. Its potency against antibiotic-resistant bacteria, such as MRSA, makes it a particularly invaluable tool in an age where more strains of resistant bacteria are developing. To what extent other honeys do the same is unclear but probable. There no data on the effect on honey on weeping wounds but if infection is contributing to the weeping then, in theory, honey should help.

I am assuming you already have lymphoedema. If so the weeping is lymph coming out through the wound. It is worse because there is more oedema and the pressure of lymph in the leg is higher. This could be for a number of reasons including infection. A proper clinical consultation is required to give you the best advice

Dr. Mortimer’s Response:

There are many different causes for folliculitis such as infection, acne, occlusion with creams, and friction to name but a few. Antibiotics such as a tetracyclines can help both infection and acne. If the folliculitis comes straight back then the cause is still active and needs to be identified and addressed otherwise the folliculitis will not get better.

Thank you for your enquiry
It is likely you are suffering recurrent cellulitis, a well known complication of any form of lymphoedema. Because it may be the same infection never clearing, prophylactic antibiotics are recommended.
Please refer to the UK national guidelines for management of cellulitis in lymphoedema
Please google ‘lymphoedema cellulitis guidelines’ and click on the pdf

I am sorry but I did not receive the email alert and so have only just seen this since logging in to the LE&RN; website

The answer is that your birthmark could well be a lymphatic malformation. Often little fluid filled blisters appear on the skin surface and can weep fluid. At times they can contain blood. Ask your doctors to consider a lymphatic malformation or a mixed (blood and lymphatic) malformation.

Best of luck

Thank you for this interest.
The book entitled ‘Let’s talk Lymphoedema” is available through Amazon or through the publisher Elliott & Thompson:
Marianne Thorndahl
Operations Manager
Elliott & Thompson
27 John Street
London WC1N 2BX
http://www.eandtbooks.com
T: 020 7831 5013
@eandtbooks

As for the small book on self management published by Beaconsfield publishers I am not sure because the publisher has retired

The likelyhood is that you are experiencing symptomatic dermographism which means that release of pressure is inducing an urticaria or histamine reaction (nettlerash). An anti-histamine e.g. citirizine should improve symptoms and confirm the diagnosis.

Not really, although steroids by mouth for any length of time would be unwelcome

There is no easy way! You could afford to leave alone and treat only if the keratosis progresses or becomes tender. 40% of keratoses can disappear spontaneously.
If you have to treat there are a number of various chemo/immunomodulating creams but probably the most gentle way is to apply 5 fluoruracil cream on two consecutive days each week for 6 weeks, or less if inflammation starts to develop before finishing the course.

Peter Mortimer

Dear Ahmed,

One needs to aware that tissues affected by lymphoedema have sub-optimal immunity because of disturbed immune cell trafficking. Consequently the immune cells do not clear infection properly and it is very likely that ‘resistant infection’ means infection is not being eradicated. Current advice is to give prolonged course of antibiotics for recurrent cellulitis and even prophylactic antibiotics, and even then infection may still recur. There is no simple answer
Please see
lymphoedema.org and click on cellulitis

Peter Mortimer

Thank you for your enquiry.  There are many different causes of genital lymphoedema and further investigation should be undertaken.  For example, without any prior history of lymphoedema it is likely to be caused by an inflammatory process.  Such inflammation could be caused by infection or non-infective inflammatory disorders such as ano-genital granulomatosis.  He needs to see a specialist with knowledge of this problem.  Cycle shorts and other forms of compression will not work unless the underlying cause is addressed.  I hope this helps.

Thank you for this enquiry
Steroids by mouth e.g prednisolone, cause retention of water in the body and so can exacerbate lymphedema by increasing lymph production.

Thank you for your enquiry
The information I give is based on opinion as there is no evidence to answer this question.
If you have had cellulitis before then definitely cover the period of the surgery with antibiotics ( 24 hours before and 1 week after).
If you have never had infection then it is a difficult decision but probably safer to have them.
It is also important to try and get the swelling down as much as possible before surgery and perhaps have lymphedema treatment post surgery as well to control swelling. That is our standard practice at St George’s, London

Peter Mortimer

As per Dr. Mortimer-
Thank you for your enquiry. Removal of even one lymph gland from the armpit (axilla) increases the risk of lymphoedema. Onset of lymphoedema after lymph node removal is variable. It can be immediate or may be delayed. The reason is not always clear. Therefore, I suggest onset in your right arm could have occurred at any time. Factors like infection or trauma (accidental or from further surgery) often trigger the onset. I also believe there is a genetic predisposition but there is currently no evidence to confirm that view.

Hope this response is understandable

Dear Simon,
Apologies for delay but have ben on holiday.
I am very familiar with the Oxford Lymphoedema Practice team. They have far more experience of LVA surgery than anybody else in the UK. Their results are as good as any published data. By that I mean that the microsurgery can improve swelling but probably by no more than 15-20% on average. It is not a cure and most patients still have to wear a compression garment. For those patients who suffer recurrent cellulitis it also appears to reduce infection rates.
The Oxford team have tried to get the procedure approved on the NHS but they have failed on many occasions. Occasionally it has been done on the NHS at Chelmsford hospital.
Hope this helps

Professor Peter Mortimer

Dear Nina,

By VLNT I presume you mean vascularised lymph node transfer, otherwise known as autologous lymph node transfer.
The jury is still out as to how effective this surgery is. The average volume reduction is less than 10% so it will not cure your lymphedema, furthermore there is a small risk of causing lymphedema in the region from where the lymph nodes are taken. Therefore proceed with caution. Recommendations regarding who to see depends on where you live.
Thank you for the enquiry

Professor Peter Mortimer

Dear Sue Jo,
Thank you for your enquiry to LE&RN;. Much depends on what you call “lymphedema in the stomach’ as I doubt anybody could diagnose lymphedema of the actual stomach. If you mean lymphedema of the abdominal wall, then that is probably linked with your leg oedema and that would be treated in the same way i.e. massage and compression (abdominal binding), but investigation to find out why it is getting worse would be sensible. If you mean lymphedema of the internal organs then that needs specialist investigation. The St George’s Hospital lymphedema clinic in London is experienced in undertaking such investigations and would be prepared to see you if your lymphedema clinic referred you.
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Dear Angela,

Yes, I am sure that use of a self tanning lotion would be safe. These products have an active ingredient which combines with dead cells on the surface of the skin to create the colour. It naturally disappears after a few days. What you might find is that your lymphoedema leg goes a different colour from you other leg due to the thicker skin in lymphoedema.
Therefore I suggest you do a trial before you go

Professor Peter Mortimer

Apologies for delay but I have been away without a computer.
Your son’s malformation may well be purely lymphatic and not lymphovenous as it is often impossible to distinguish between the two.
I would not recommend biopsy as that may risk infection, poor healing, lymph leakage and, besides, it is very unlikely to change management.
Surgery is also unlikely to solve the problem as it is very difficult to remove these malformations (birthmarks) and they can simply return. If they cause no symptoms I often do nothing. If they have quite large cysts containing lymph then injection sclerotherapy by an experienced radiologist is probably best (bit like injecting varicose veins).
happy to see at St George’s in London

Professor Peter Mortimer

As per Dr. Mortimer
Answer:
The first consideration must be for a fungal infection and there would be no harm in buying terbinafine (Lamisil) cream and applying at night for 2 weeks. More likely is dryness related to the hardening of skin associated with the lymphoedema skin changes plus effects of cold winter weather (assuming you are in northern hemisphere). 25% urea heel balm (Flexitol) would be worth using as well as bandaging the toes at night if they are swollen

Dear Joyce
Thank you for your enquiry
First of all I cannot criticise your doctors one bit as they quite rightly prioritised and your lymphedema came a distant second when it was a matter of life and death!
It is true to say that the risks of worse swelling or cellulitis following a sterile puncture are extremely small but if you happen to be the one who gets that complication then it is not acceptable.
As for tourniquets, again, there is a theoretical risk of worse swelling because of the sudden flush of blood and fluid into the arm when the tourniquet is released but as with a blood pressure cuff that risk is very small.
I would not describe you as lucky to have had a cardiac arrest but you would have been very unlucky to have suffered worse lymphedema

Thank you for your enquiry
It is difficult to give a diagnosis without seeing and examining your father. Shingles does not cause a lymph problem. He needs an ultrasound examination or a CT to determine the nature of the swelling so that the correct treatment can be given.
The skin will remain sensitive because of the nerve damage from the shingles.
Your other questions are all dependent on the diagnosis.
If he is in Holland and his doctors think this is a lymph problem then I suggest he consults with Dr Robert Damstra in Groningen
Sorry not to be more help

As per Dr. Mortimer-

A: This is likely to be primary lymphoedema (PL) because of the age of onset and because there has been no known damage to the lymph system. Many forms of PL are not inherited but the exact risk to offspring is dependent on the type of PL you have. This can only be determined through an expert who can characterise the type of primary lymphedema you have and if appropriate gene testing.

As per Dr. Mortimer-

The large lump that has grown on the inner thigh is presumably a large lymphoedema fold although without imaging such as ultrasound examination one cannot be sure. Treating lymphoedema folds is difficult and needs very skilled bandaging. It is important to ensure there is no (over)weight issues as that makes these folds more likely to develop, and more difficult to treat. If all else fails one might have to consider liposuction but everything depends on the circumstances of this patient. Reconstructive lymphatic surgery is unlikely to be an option.
The biggest lymphoedema centre in the UK is at St George’s Hospital in London. The lymphoedema Support Network in the UK (http://www.lymphoedema.org/lsn) should be contacted for advice”

As per Dr. Mortimer-

“Recurrent infections are a common occurrence with lymphoedema.  It is also very common for the effects of the infection to develop rapidly.  Patients can feel fine one minute and within 15 minutes feel ill with chills and flu-like symptoms.  This is because of the effect lymphoedema has on immune cell trafficking and function within the swollen region.  Research has shown that it is not helpful to give antibiotics only when infections occur.  The infections need to be prevented and the recommendation is for prophylactic penicillin.  Advice for patients on this subject can be found at
http://www.lymphoedema.org/Menu3/Cellulitis Consensus.pdf

The hyperkeratosis seen with lymphoedema reflects an increase in the horny layer (keratin) on the surface of the skin.  It is related to the increased thickening of the skin which is often called elephantiasis because it represents elephant skin.  The hyperkeratosis is different from a keratosis which is a benign tumour on the surface of the skin usually resulting from sun damage. 

Therefore the hyperkeratosis seen with lymphoedema is simply an excessive production of mature keratin from normal keratinocytes.  A keratosis is related to a hyperplasia or dysplasia of the underlying keratinocytes which are the cells responsible for producing the keratin.

Patients with existing lymphoedema do find that it temporarily deteriorates during a flight.  However it should return to its former condition within 24 to 48 hours of arrival providing there are no complications eg infection.  For patients with existing lymphoedema the recommendations are to wear the compression garment, perform regular exercises during the flight, elevate the swollen area as much as is feasible and ensure no dehydration.  The problem with air travel is inactivity and the cabin pressure.  On arrival it is worth undertaking exercise to stimulate lymph drainage.

In general lymphoedema does not affect psoriasis and therefore one would treat the psoriasis in the normal way with ultraviolet light therapy as creams are not that effective. Psoriasis could be,in theory, worse on a limb affected by lymphedema because of the alteration to immune cell trafficking from the compromised lymph drainage. Therefore it makes sense to treat the swelling as well as one can and ensure no infection (as infection can exacerbate psoriasis)

I am not convinced from your history that you do have lymphoedema with angioedema.  Angioedema manifests with bouts of swelling which settle within minutes or over a few hours.  It is thought to be allergic but no cause is usually found.  It is certainly inflammatory and will respond to oral steroids.  There are reports in the literature of recurrent angioedema giving rise to lymphoedema.  However under those circumstances the lymphoedema swelling is persistent and usually affects sites such as the skin around the eyes, mouth or ears.  I would agree that your circumstances do not fit in with the norm either for angioedema or lymphoedema and therefore it is difficult through an online response to advise.  My suggestion would be to see a lymphoedema physician if possible.

Thank you for this interesting question.  You are right in saying that guidelines recommend avoidance of needle puncture/surgery/tourniquets in/on the at-risk arm following breast cancer treatment.  The concern is that swelling could be precipitated.  Furthermore there is always the risk of infection (cellulitis) which could also precipitate long-term swelling.

Therefore in an ideal world one would advise against trigger finger surgery but one has to do a risk/benefit analysis.  If there is no alternative to your trigger finger then you should undergo surgery.  However I would ask your surgeon if it can be done without tourniquet (assuming the tourniquet is around the upper arm or forearm).  It may also be worthwhile covering the period around the surgery with antibiotics although there is no evidence that this is necessary.

I am afraid I don’t know the risk analysis of inducing lymphoedema but I would expect it to be very low with surgery alone and higher if the tourniquet is added.