Skin and Nail Care for Lymphedema

Skin and nail care is important to preserve the condition (integrity) of the skin and nails to help prevent infections.

A breakdown in the skin leads to a high likelihood of infection.  It is for this reason that good personal hygiene is also maintained.  In more advanced cases of lymphedema it may be difficult for a person to reach affected areas of their body.  If this is the case, having a caregiver regularly clean and inspect difficult to reach areas such as creases, folds, or lower legs/feet.

Using a low-pH lotion before bandaging is helpful to help preserve the integrity of the skin.

 

Infections and Lymphedema

The protein-rich fluid that is stuck between the cells in lymphedema is the perfect medium to grow bacteria.  Any time infection is suspected when you have lymphedema, it demands immediate attention as these infections can be dangerous.  The most common infections with lymphedema are cellulitis and erysipelas.  Erysipelas is more superficial than cellulitis, but they are both usually treated the same way.  Knowing the difference is not important.

It is important to always clean any cuts or abrasions that you may get on an area of the body affected by lymphedema. Keep a very close eye on the area for signs of infection until it is fully healed. Note that infections can happen in lymphedema without an open wound.

What follows are general guidelines regarding infections and lymphedema.  They are not a substitute for medical advice and are intended only to present common scenarios for general educational purposes.  Always consult with a medical professional when making decisions if you suspect you have an infection.

Watch for these signs:

• Skin that feels warm or hot
• Redness or rash
• Fever of 100 degrees or more

Should the area become red and start to spread slowly, see your doctor or go to urgent care.  You will likely be prescribed oral antibiotics.  Once on antibiotics the symptoms should stop worsening after 2 days and begin to improve gradually after 3 days.  Pain, itching, and heat will likely go away first, but the redness can persist and take significantly longer to go away.  If your symptoms are still getting worse on the third day, check in with the doctor for a follow-up.

On the other hand, if the red area quickly becomes very hot, painful, and is rapidly spreading through the limb, go to the ER – especially if you have a fever.  This may be a medical emergency that would require IV antibiotics and careful monitoring by medical professionals. 

 

Prophylactic Antibiotics for Lymphedema

Some doctors advise taking antibiotics prophylactically if you get a cut and have a history of recurrent infections, but this is certainly not without its own risks.  You should discuss the pros and cons of this with your doctor.

It is important to forego any lymphatic drainage if you have an active infection as it can worsen the infection and possibly cause a life-threatening crisis.  Once the infection is well controlled with antibiotics – commonly 3-5 days after starting the antibiotics – it is generally safe to proceed with lymphatic work.  Again, this timing is a general scenario.  You should check with your doctor to ensure it is safe to resume lymphatic therapy.