Use of Hyaluronidase by Iontophoresis in Treatment of Lymphedema

Lymphedema is a swelling of soft tissues, the result of accumulation of increased quantities of lymph. A useful clinical classification by Allen, Barker, and Hines,¹ modified by Duryee,* divides all cases into two main groups; inflammatory and noninflammatory.

• Noninflammatory

  1. Primary

     1. Congenital lymphedema

        • Hereditary or familial (Milroy's disease)

        • Lymphedema praecox

  2. Secondary

     1. Malignant occlusion

     2. Surgical removal of lymph nodes

     3. Pressure

     4. Radiation therapy

     5. Venous insufficiency

• Inflammatory

  1. Primary (single or recurrent acute and chronic)

  2. Secondary (single or recurrent acute and chronic)

     1. Trichophytosis

     2. Systemic disease

     3. Local tissue injury or inflammation

     4. Filariasis

Lymphedema has been poorly responsive to numerous forms of treatment short of extensive surgery. For this reason, any method which might promise some improvement of the frequently disabling and disfiguring features of this condition, and which is clinically feasible, should be investigated.

Hyaluronidase, the "spreading factor," was first described in 1929 by Duran-Reynals.² Additional knowledge of its biological significance was contributed by