Lymphostatic fibrosclerosis of the skin organ L98.8

A term in lymphology that describes the clinical manifestation of a circumscribed, chronic lymphostasis of the skin, independent of cause.

Clinically, lymphostatic fibrosclerosis of the skin organ, e.g. in the case of localization at the toes (in the case of lymphedema of the feet), is characterized by a positive stemmer sign, which is defined by a thickened skin fold with induration and papillomatosis over the second back of the toes. Lymphostatic fibrosclerosis of the skin organ can also occur in other topographical regions in the case of a pre-existing chronic lymphedema, for example in the genital area, on the upper extremity (e.g. after mamma amputation with radical lymphadenectomy and possibly post-operative radiotherapy), on the abdomen (apron in the case of obesity per magna) or in the mammary area.

Clinically prominent and strictly limited to the area of chronic lymphangiopathy, there is an extensive induration of the skin (skin can no longer be folded without further ado) with bulging skin folds and edge formations. If the lymphostasis persists, a verrucous surface field of the skin with brownish-blackish tingling (papillomatosis cutis lymphostatica) occurs. Long-term and severe lymphostasis can lead to small lymph cysts and lymphorrhoea with constant wetting and consecutive maceration of the skin.

Numerous dilated lymphatic vessels, with thickened dermis with densely packed, eosinophilic widened collagen bundles with immured adnexa.

maceration, recurrent bacterial (e.g. erysipelas) or mycotic (tinea, yeast infections) infections In particular erysipelas tend to recurrent courses with increasingly less symptomatic recurrences. Without therapy, skin-near structures such as muscle fasciae, tendons, ligaments and joint capsules with limited mobility may be involved, especially if the lower extremity is affected.

Corresponds to the therapy of chronic lymphedema with manual lymphatic drainage, compression therapy (in case of localisation at the extremities), exercise, skin care, instruction for self-management.

1. Dissemond J et al (2018) S1 Guideline - Dermatoses in dermal lymphostasis. J Dtsch Dermatol Ges 16:512-524.