Twenty-two patients with factitious lymphedema of the hand were
reviewed. Thirteen were female, with a median age of sixteen years at the
onset of symptoms. Of the nine males, the median age at onset of symptoms
was thirty-two years. The dominant hand was affected more frequently than
the non-dominant hand. Edema was usually caused by a tourniquet, irritation
of the skin, or blows to the back of the hand. Neurosis, psychosis, or
suicidal tendency was diagnosed in twelve of these patients.
Characteristically, the edema was not particularly painful; it frequently
ended proximally in a circumferential discolored constriction ring; and it
occasionally displayed characteristic lymphangiographic findings of normal
or dilated lymphatic channels with increased collateral circulation and
multiple blowouts. Although ten of the patients received Workmen's
Compensation benefits, the course and psychiatric diagnosis indicated that
malingering for secondary financial gain was not a primary goal.
Hospitalization is usually required to confirm the diagnosis. Psychotherapy
is indicated once the diagnosis is made.