Brawny edema is a much more severe form of non-pitting edema and usually present in later stage of non-pitting edema. Brawny edema can affect any part of the body, though mostly occur in the lower extremities. The chronic condition causes the skin to become thick, brown colored, induration, liposclerosis, atrophic and even necrotic.
Causes of brawny edema
The primary cause of brawny edema is metabolic abnormality which leads to fibrotic changes that occur in the subcutaneous tissue on the outer layer of the skin.
The brown color of the skin, which is characteristic to brawny edema is due to the deposition of hemosiderin from the lysed red blood cells.
Here are some conditions that may cause brawny edema:
Lymphatic obstruction, removal of or injury to lymph nodes may result in lymphedema leading to chronic brawny edema. Brawny characterizes lymphedema can present in one or both lower extremities. Read also Fluid Retention in Legs - Peripheral Edema.
In the early stages of lymphedema, the skin has a doughy appearance, and in the later stages, it becomes fibrotic, thickened, and verrucous leading to brawny edema.
This can happen in case of: tumor, infection (filariasis), previous pelvic surgery, mastectomy, inguinal lymphadenectomy, Hodgkin’s lymphoma, congenital defects (congenital lymphedema - Milroy’s disease), trauma, previous radiotherapy.
Use of pneumatic compression devices or elastic compression stockings may be helpful in these cases.
Brawny edema may occur in cases of increased glycosaminoglycan content due to pretibial myxedema (myxoedema) or in early phase of scleroderma. Pretibial myxedema is a swelling over the shin that occurs in some people with hypothyroidism.
It can occur too in patients with Graves disease. Grave’s disease causes interstitial dermopathy, which leads to water retention in the interstitial space.
Lipedema is a chronic disease of lipid metabolism characterized by a bilateral and symmetrical swelling of the lower extremities.
Brawny edema of the lower extremities from lipedema usually occurs between the pelvic crest and the ankle, symmetrically on both sides. Lipedema often starts around puberty. The exact cause of it is not known.
Other possible cause of extensive brawny edema is renal insufficiency due to renal conditions like nephritic and nephritic syndrome.
Chronic brawny edema can also develop from untreated chronic edema. Chronic edema results in decreased blood flow. If left untreated, it will lead to chronic ischemia causing skin atrophy, dryness of skin, scaling and itching, ulceration and necrosis. Thus, it is best to treat any form of edema as soon as possible.
In lymphedema the lymphatic vessels are blocked. The excess fluid in the tissue can’t move into the circulation, therefore pressure doesn’t leave a pit in the skin. Brawny edema after a mastectomy usually occurs in the arm on the side of the surgery where the regional lymph nodes have been removed or damaged.
In myxedema, there are also other tissue under the skin, not only the fluid, which causes edema.
Venous edema is not brawny edema
Venous edema from Chronic venous insufficiency may cause a brawny, reddish hue skin, especially in the medial malleolus. But, venous edema is different from lymphedema. Edema caused by chronic venous insufficiency is pitting in nature, whereas edema from lymphedema is non-pitting “brawny edema”.
Symptoms of brawny edema
The symptoms of brawny edema often depend on the underlying cause. It can be diagnosed through clinical examination. The skin of the affected area is usually thick and brawny. There is usually a red or dark discoloration along the affected limb. The pressure test doesn’t form an indentation on the skin at all, but swelling can still be observed. The skin becomes harder and thicker and often features a red or dark discoloration along the affected limb.
Brawny edema treatment
Brawny edema is difficult to treat. Moreover, brawny edema often indicates one or more serious underlying medical conditions, thus important to find the underlying cause of the edema and exclude other possible conditions in order to determine the best course of treatment.
Treatment includes usage of medications, physical therapy, surgery and different remedies, such as:
- Compressions with medical support hose such as elastic stockings, wraps or bandages keep fluid from accumulating in the affected area
- Pneumatic compression devices
- Manual lymphatic drainage
- Simple exercises of arms or the legs to improve lymph or venous blood flow and reduce fluid buildup
- In some cases of lymphedema, surgery is used to remove excess fluid, or in severe cases, tissue
- Liposuction to remove lipedema fat in lipedema patients
- For brawny edema from Grave’s disease, use of hydrocortisone cream can be effective. Hydrocortisone cream is widely used to reduce itching, redness, irritation and swelling associated with many skin conditions. Also, compression stockings can be used
- Diuretic medications are generally not effective, but in some cases, they might provide relief
- Restrict the intake of salt and other dietary changes may also be effective. Read Too Much Salt or Excess Sodium Intake.
- Elevation of the legs periodically during the day may reduce the swelling.