Lymphedema of the extremities is a common manifestation of chronic lymphatic filariasis, what progression on translates elephantiasis. Usually the lower limbs are involved, either unilaterally, or sometimes on a bilateral level, in which case the swelling tends to be asymmetrical. The upper limbs, the male genitalia and rarely the breasts in females may also be affected. Lymphedema of the members is noted generally as follows.
Grade I – Pitting edema, reversible.
Grade II – Pitting or non-pitting edema, irreversible on elevation of the affected limb and there are no skin changes.
Grade III – Non-pitting edema that is irreversible and thickening of the skin.
Grade IV – Non-pitting edema that is irreversible, with thickening of skin along with nodular or warty excrescences – the stage of elephantiasis. At an advanced stage of lymphedema, the skin is thickened and thrown into folds, often with hypertrichosis, black pigment, nodules, glandular growth, and intertrigo in food webs of the toes or chronic ulcers non-guerison. The swelling can be so huge and grotesque that the patient is incapable in need of assistance, even for personal needs. Fungal infections in the interdigital area and in the deep creases are a common finding in advanced Lymphedema.