Still later, hyperpigmentation and hyperkeratosis develop, often with wartlike protuberances which, on histological section, reveal dilated loops of lymphatic vessels within the nodular lesions. Patients with chronic lymphedema or elephantiasis rarely are microfilaremic. Redundant skin folds, of the skin provide havens for bacteria and fungi to thrive and intermittently penetrate the epidermis to lead to either local or systemic infections. Sometimes the skin over the breaks down, causing the dilated lymphatic within to rupture and discharge its lymph fluid directly into the environment, at the same time serving as a causeway for penetration of bacterial or fungal organisms directly into the lymphatic system.

Chyluria, another of the chronic filarial syndromes, is caused by the intermittent discharge of intestinal lymph (chyle) into the renal pelvis and subsequently into the . The clinical course is intermittent, sometimes remitting.