Brawny Edema

If you have edema, it may be either pitting or non-pitting (brawny edema). Accumulation of fluid in cells and interstitial space is referred to as edema. In an individual’s body, there is some fluid present in the interstitial space and that fluid accounts for about 20 percent of a person’s body weight. Health conditions may at times cause the amount of fluid in body to increase leading to edema. Edema may be classed into two groups:

• Pitting edema
• Non-pitting edema

When you press on the skin of a person with edema and you see a mark like a dent is left, that’s regarded as pitting edema. With non-pitting edema, there is no mark that is created. Non-pitting edema is also referred to as brawny edema.

Brawny edema occurs in the later stages of the non-pitting form of edema. The prolonged occurrence of edema causes a chronic condition that makes an individual’s skin to be thick, brown, atrophic, and necrotic. Edema may be a symptom indicating various conditions. The condition arises when the interstitial space receives more fluid leaking from the blood vessels. It may also occur when fluid moves from interstitial space to blood vessels is a slow way.

Brawny edema is divided into two main types namely: lymphedema and myxedema. The former involves blockage of the lymphatic vessels meaning excess fluid present in the tissue is unable to get into the circulation system. When this is the case, pressure created on the skin doesn’t cause a pit or dent. Myxedema, on the other hand, involves not only the fluid but also other tissue underneath the skin. Since there is prolonged or chronic stasis of fluid, this situation reduces blood supply in the areas affected making the tissue to be deprived of oxygen.

What Causes Brawny Edema?

 The mechanisms behind brawny edema fall under either myxedema or lymphedema. In lymphedema, there is removal, alternation, or obstruction of lymph nodes a situation that can happen when there is an infection like filariasis. Other things that can cause this problem are tumor, surgery, radiotherapy, trauma, congenital defects – for example- congenital lymphedema, and mastectomy. Surgery may also be a culprit in causing lymphedema.

Myxedema arises due to a disorder known as Grave’s disease. This disease leads to interstitial dermopathy, which in turn contributes to building up of fluid within the interstitial space. It is also possible for brawny edema or non-pitting edema to arise from lipedema. In lipedema there is fluid building up within the tissue including fatty tissue. While this edema mostly sets in around puberty, it is not known what exactly causes it.

 

Brawny Edema Symptoms

 Symptoms related to edema usually depend on what is causing the problem. Edema in most cases affects lower extremities. If an individual has had mastectomy, edema can affect the arm that is on the side where surgery has been done. In this case, the edema attacks the area where lymph nodes are damaged or removed following the surgery. Symptoms may include:

• Skin that is hard and has a thick feeling
• When you press a finger on that skin, there isn’t pitting but you can notice the swelling
• There is reduced blood flow in case of chronic edema
• Brown skin color – this is usually as a result of hemosiderin arising from the lysed red cells

When chronic edema develops, it leads to chronic ischemia that presents with symptoms like:

• Skin atrophy
• Scaling
• Itching
• Dryness in skin
• Ulceration
• Necrosis
  

Diagnosing Brawny Edema

 A clinical examination is done to help diagnose a patient of brawny edema. Usually, the skin is thick and non-pitting (no pit is left when you press the skin using the finger). A doctor orders for blood analyses to find the underlying cause and rule out the possibility of other health conditions. Blood analyzes include:

• Liver enzymes
• Complete blood count
• Kidney function markers
• Thyroid hormone levels to check for Grave’s disease
• Genetic tests to examine congenital defects
• Infection markers or specific antigen and antibodies- these can help exclude filariasis.

A doctor may further conduct imaging studies to help rule out acute situations:

 Ultrasound: This imaging test helps to rule out the possibility of deep venous thrombosis. It also helps to examine and assess thyroid gland.

 Magnetic resonance imaging: This test helps to establish what may be causing lymph node blockage. To find out the exact location of blockage, T1-weighted magnetic resonance lymphangiography is conducted.

 CT and MRI scans: These tests help to see if there is a tumor that has attacked the lymph nodes

 X-ray mammogram: This test is performed to rule out the presence of breast cancer.

 

 

Brawny Edema Treatment

 The treatment of brawny edema can be very difficult and in most cases, it will depend on what is causing the problem. Different medications, surgery, physical therapy, and other remedies are involved in the treatment regime.

In case of lymphedema, there is no cure, however, treatment is done mostly focusing on reducing symptoms and any discomfort the patient has. The treatment involves use of:

• Elastic stockings or sleeves
• Pneumatic compression devices – these can help prevent scarring, however, they are not intended for use in people who have congestive heart failure or infection
• Bandages
• Manual compression involving lymph drainage and massage
• Exercises to help in stimulating lymph flow
• Surgery to extract excess fluid or even tissue in severe cases.

In case of lipedema, there is also no treatment; however, management of the condition can be done using various methods. Although weight loss can help in preventing the advancement of edema or infections, it isn’t effective to treat edema. Lipedema may be managed by other methods like:

• Using compressions with wraps, stockings, or pneumatic compression
• Manually draining the lymphatic fluid
• Exercises may help remove fluid that has build up and to increase mobility
• Removal of lipedema fat may be done using liposuction

If Grave’s disease is a culprit in causing edema, treatment is aimed at tackling the underlying condition. Radioactive iodine therapy can be used to treat the condition. Part of the thyroid gland may be removed surgically. Hydrocortisone cream may also help in brawny edema. This substance is used to treat many skin conditions. Again, compression stockings and wraps are also used in case of Grave’s disease.

If a tumor has been implicated as the cause of brawny edema, surgery may be performed to get rid of it. Sometimes, radiotherapy may be stopped because when not used, it helps in treatment of edema. However, a surgeon has to weigh the risks of not using radiotherapy after surgery in the case of removing and treating a tumor against the use of the procedure. This way, it can help determine whether to have radiotherapy conducted or not.