From the Guidelines
Nonpitting edema is most commonly caused by conditions such as lymphedema, myxedema (from hypothyroidism), and lipedema, where fluid accumulates in tissues and does not leave a temporary indentation when pressed with a finger. This type of edema is characterized by its non-pitting nature, which distinguishes it from pitting edema. The underlying causes of nonpitting edema can vary, but they often involve conditions that affect the lymphatic system, thyroid function, or fat distribution in the body.
Some key conditions associated with nonpitting edema include:
- Lymphedema: a condition where the lymphatic system is impaired, leading to fluid accumulation in the affected limb 1
- Myxedema: a condition caused by hypothyroidism, where fluid accumulates in the skin and other tissues due to decreased thyroid hormone production
- Lipedema: a condition characterized by the abnormal distribution of fat in the body, leading to swelling in the affected areas
Treatment for nonpitting edema depends on the underlying cause, but it often involves:
- Elevation of the affected limb to reduce swelling
- Compression garments to help reduce fluid accumulation
- Addressing the primary condition, such as hypothyroidism, through medication or other treatments
- Complete decongestive therapy, including manual lymphatic drainage, compression, exercise, and skin care, for lymphedema
It's essential to note that diuretics, such as furosemide, are generally less effective for nonpitting edema than for pitting edema, as the fluid accumulation in nonpitting edema is often trapped in tissues or mixed with proteins, making it more challenging to displace with diuretics 1. Patients should monitor for signs of infection in affected areas, maintain good skin hygiene, and follow up with healthcare providers to ensure appropriate management of the underlying condition.
From the Research
Causes of Non-Pitting Edema
- Non-pitting edema can be caused by lymphedema, which is characterized by the accumulation of fluid in the interstitial space due to insufficient lymphatic drainage 2, 3.
- Lymphedema can present as brawny, nonpitting skin with edema, and possible secondary causes include tumor, trauma, previous pelvic surgery, inguinal lymphadenectomy, and previous radiation therapy 2.
- Angioedema is another cause of non-pitting edema, which can be asymmetric and affect the face, lips, tongue, and mucous membranes 4.
- Non-allergic angioedema can be distinguished in five major forms: acquired, hereditary, renin-angiotensin-aldosterone system blocker-dependent, pseudoallergic angioedema, and idiopathic angioedema 4.
- Venous stasis due to immobility can also cause non-pitting edema, especially in patients with severe gait disturbance and no significant venous abnormalities 5.
Characteristics of Non-Pitting Edema
- Non-pitting edema is characterized by tense, non-pitting skin with thickened epidermis due to accumulation of protein and lipids in the connective tissue 3.
- In the early stages of lymphedema, pitting edema may be seen, but with progression of the disease, fibrosis occurs and the edema becomes tense 3.
- Non-pitting edema can be a clinical picture of chronic lymphedema, which can cause significant disability due to limb swelling 3.