Factitious lymphedema of the hand.

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.