Which symptom is often associated with primary lymphedema as indicated by Stremmer's sign?

Stremmer's sign is a clinical test used to identify the presence of lymphedema, particularly in the lower extremities. The sign is positive when the skin fold over the second toe cannot be easily pinched or lifted. This indicates that there is swelling related to lymphatic system dysfunction, which is often seen in primary lymphedema. The thickening and fibrosis of the skin in this region is an important marker of lymphedema, making thickened skin folds a significant finding.

The other symptoms, while related to vascular or lymphatic issues, do not directly indicate Stremmer's sign or primary lymphedema. Swelling of the leg is a general symptom that can be associated with various conditions and does not specifically highlight the importance of skin fold assessment. Varicose veins are related to venous insufficiency and do not reflect the lymphatic issues of primary lymphedema. Hyperpigmentation may occur in chronic venous insufficiency or other conditions affecting the skin but is not diagnostic of Stremmer's sign or its implications in lymphedema. Thus, thickened skin fold directly correlates with the assessment of lymphatic function and best represents the symptom associated with