Vascular and lymphatic abnormalities

Skin manifestations caused by vascular and lymphatic abnormalities are numerous. Damage to blood vessels whether through inflammation, arterial atherosclerosis or venous hypertension results in restricted blood flow, hindering micronutrient and oxygen delivery to the local skin. Localized cutaneous changes can give clues regarding aetiology, and localized ischaemia and ulceration can result in significant morbidity. The lymphatic system has been a neglected area of medicine, but the discovery of lymphatic-specific genes and immunohistochemical markers has revolutionized knowledge of lymphatic biology and involvement in diseases such as infection and cancer. Lymphoedema results from a failure of lymph drainage because of a genetic fault and/or secondary damage to the lymphatic channels. Clinicians must be aware of the multifactorial causes of swelling and the associated cutaneous changes, including sequelae such as lipodermatosclerosis and cellulitis, which can often be diagnostically challenging.