Вроджена лімфедема — це не тільки естетична проблема (клінічні випадки)

Lymphedema is a chronic disease of the lymphatic system that can be associated with genetic mutations or iatrogenic (medically induced) effects. It results in structural changes in the lymphatic vessels, leading to obstruction and impaired lymph circulation. The progressive swelling of tissues manifests as enlargement of certain body areas, most often the lower limbs, primarily in people of working age. This condition significantly reduces the patient's quality of life due to functional limitations and psychosocial consequences. Objective — to present clinical cases of congenital lymphedema in individuals of different ages and to summarize the available information on this pathology in order to increase clinicians’ awareness. To highlight the tactics of a dermatologist and emphasize the importance of interdisciplinary cooperation in the management of such patients. Materials and methods. We described clinical cases of congenital lymphedema in girls aged 16 and 12, and a 34-year-old woman. Common complaints were: onset of the disease without apparent cause, gradually increasing swelling, impaired motor function, pronounced aesthetic defect, and depressed mood. Results and discussion. The most well-known forms of congenital lymphedema are Milroy disease and Meige disease, which have a genetic basis. In the differential diagnosis with acquired forms, it is important to consider family history, the onset of the disease, and its association with trauma or infection. Lymphoscintigraphy is considered the gold standard for diagnosing lymphedema, as it allows detection of aplasia or hypoplasia of lymphatic structures in congenital forms and, in acquired forms, obstruction or damage to them. Conclusions. Lymphedema is a complex, chronic condition that involves more than simple swelling, and it requires continuous care and the coordinated involvement of various specialists. Patients often seek medical help primarily due to visible changes in their body shape and skin appearance. In this setting, the dermatologist’s role extends beyond identifying skin alterations to guiding further management, ensuring proper skin care, and preventing infections such as mycoses, erysipelas, and cellulitis. Essential care components include daily hygiene with neutral-pH cleansers, intensive moisturizers to restore the skin barrier, and timely referral to physiotherapists, rehabilitation experts, or vascular surgeons for comprehensive therapy. Treatment strategies range from conservative measures — manual or device-assisted lymphatic drainage, compression therapy, and medication — to surgical options like lymph node transplantation or lymphovenous anastomosis, especially effective in early stages of the disease.