Edema pertains to the accumulation of fluid in the interstitial space or in the cells. Edema is categorized into two: pitting and non-pitting. A pitting edema is when you press the affected skin and it will leave a mark.
What is non-pitting edema? A non-pitting edema does not leave a mark on the skin. A perfect example of non-pitting edema is brawny edema. (1, 2, 6)
Image 1: Severe brawny edema of the lower extremities with brown spots and ulcerations.
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Picture 2: The patient with one-sided edema of the upper and lower extremities.
Image Source: healthmaza.com
What is Brawny edema?
It is the terminal phase of non-pitting edema. It causes the skin to turn brown and thick. It will even come to a point where the skin becomes necrotic. It is linked with fibrotic changes that occur in the subcutaneous tissues along with the top layer of the skin. It can occur in any parts of the body, although it commonly affects the lower extremities.
Edema is not a medical condition itself, but a symptom of an underlying serious health condition. There are two types of brawny edema.
- Lymphedema – There is a blockage in the lymphatic system resulting in impaired circulation of the excess fluid in the tissues.
- Myxedema – The edema is caused by an accumulation of fluid and tissues under the skin. (2, 3, 4)
What are the causes of brawny edema?
- Circulatory dysfunction as a result of chronic venous insufficiency and lymphatic obstruction.
- Renal insufficiency
- Tumor (3)
- Congenital defects
- Side effect of radiotherapy
- Grave’s disease
- Lipedema (fluid build-up in the tissues along with fatty tissues) (5)
What are the symptoms of brawny edema?
The clinical manifestations primarily depend on the underlying cause. If you palpate the skin, you will notice that it is thick and hard. If you press a finger on the affected site of the body, there is no pitting, but the swelling is obvious. A chronic brawny edema could severely affect the circulation of blood.
The skin will turn brown secondary to hemosiderin from the lysed RBCs. Extensive brawny edema could lead to severe dryness of the skin, skin atrophy, itching and scaling, and necrosis. (7, 8, 9, 10)
A clinical examination is done to accurately detect the presence of brawny edema. The underlying cause should be determined so that the appropriate course of treatment will be given to the patient. The doctor will order for a series of test, which includes CBC, genetic testing, and thyroid hormone level.
In some instances, an imaging study is ordered such as ultrasound and T1 weighted magnetic resonance lymphangiography. It will help detect the exact location of the blockage. MRI and CT scan can help detect the presence of a tumor that possibly invaded the lymph nodes. For suspicion of breast cancer, an x-ray mammogram is performed. (1, 3, 4)
What is the treatment for brawny type edema?
The treatment for brawny edema depends on the underlying cause. The doctor will use a variety of treatment modalities to accurately address the condition of the patient. It includes drug therapy, physical therapy, and surgery when deemed necessary. The goal of the treatment is to decrease the symptoms and discomfort of the patient. (2, 5)
Treatment guidelines include the following:
- The patient should wear bandages, sleeves, and elastic stockings to minimize the edema.
- To prevent scarring, the patient should wear pneumatic compression device, but it couldn’t be used on people with infection and CHF (congestive heart failure).
- The patient is strongly advised to lose weight to prevent edema from progressing.
- Manual compression is done in the form of gentle massage and lymph drainage.
- Gentle exercise can help stimulate lymphatic flow, gets rid of fluid build-up, and increase mobility.
- The patient is put on a low salt diet because sodium causes water retention. Avoid foods with preservatives such as canned goods and processed foods. They contain a high level of salt.
- The patient should increase his intake of high-quality protein to improve the osmolarity of the blood.
- People with edema usually lack iron in the body. Hence, it is important to add iron-rich foods like fresh fruits and nuts and green leafy vegetables.
- Edema usually affects the lower extremities. To improve the circulation, you have to keep your lower extremities elevated.
- In rare instances, the arms and calf muscles can be affected. Simple exercises of the calf muscles can help reduce interstitial edema.
- Limit your intake of sugar-rich foods, alcoholic beverages, and caffeinated drinks.
- A homeopathic drug arsenic alb can significantly improve the symptoms of edema. It helps drain excess water in the body. Other treatment approaches include oxygen therapy and acupuncture. (1, 2, 3, 7, 9)
In the case of extensive or chronic brawny edema, the doctor will resort to surgery to get rid of excess fluid and/or tissues. If there is an involvement of fat tissues, the doctor will perform a liposuction (fat removal surgery). If the underlying condition is Grave’s disease, the treatment will include radioactive iodine therapy and removal of some parts of the thyroid gland when deemed necessary.
To improve the condition of the skin, a hydrocortisone cream can be applied on the affected part of the body. If the underlying cause of brawny edema is a tumor, the doctor will have the tumor surgically removed. (3, 5, 8, 10)