Lymphedema is a chronic condition characterized by swelling in an affected limb or area of the body. Lymphedema typically manifests after trauma or following certain treatments for conditions such as breast cancer. These treatments, including surgical removal of underarm lymph nodes, chemotherapy, or radiation, may damage or destroy local lymph nodes and/or vessels.
Careful management of symptoms may slow or even halt the progression of the condition. Appropriate management typically includes manual lymphatic drainage (a sort of intensive, fluid-draining massage of affected areas), exercise, weight control and wearing medical-grade compression wear. Lymphedema is also associated with an increased risk of developing certain adverse skin conditions. In this blog, we’ll detail some of those conditions and the best ways to avoid or treat them.
Lymphedema cellulitis is a lymphedema-linked skin infection. Cellulitis is a bacterial infection of the skin that may result from poor management of symptoms. It affects deeper layers of the skin and may extend to fatty and soft tissues deep beneath the surface of the skin.
The condition can arise rather suddenly and may become quite painful. Although it is typically localized, lymphedema-related cellulitis may eventually spread further. When this infection spreads to the blood circulation (a condition known as septicemia), it can quickly lead to a potentially dangerous condition known as sepsis. Sepsis involves a massive immune system response to the infection, which can quickly lead to organ failure.
Mild cellulitis is usually treated with a prompt course of antibiotics. The goal is to prevent the infection from spreading. Accordingly, it is important to seek medical attention as soon as you notice redness, unusual swelling, heat, or tenderness in an affected area. Patients are often advised to elevate the affected limb and to get additional rest.
The swelling associated with lymphedema can cause skin folds to develop. When these folds touch, they can create an environment that encourages the growth of harmful fungi. These fungal infections can, in turn, increase the risk of developing bacterial infections. Accordingly, it’s very important for patients to keep these areas clean and dry. Washing, drying carefully, and applying a barrier lotion, such as a dimethicone or zinc-based cream can help prevent these infections from developing.
Diaper rash cream is an example of an effective barrier cream that may help prevent these infections. If a fungal infection has already taken hold, it may be prudent to apply an anti-fungal cream. Among people with lymphedema of the legs or ankles, fungal infections frequently take hold in the spaces between toes. Vigilant skincare is essential for the prevention of these complications.
Other Lymphedema Skin Conditions
Erysipelas is the term for a bacterial infection of the upper skin layers and superficial lymphatic vessels. It’s almost exclusively caused by infection of the skin with a bacterium called beta-hemolytic streptococcus; more commonly known as strep. While most often associated with severe throat infections, especially among children, this microbe can also infect the skin of individuals with lymphedema.
Affected skin typically becomes unusually red, warm to the touch, and even more swollen than usual. Often, there is a clear line between affected and unaffected areas of skin. The patient may also experience fever and chills and should seek immediate attention.
Lymphangitis is another skin condition that involves an infection that takes hold in the lymph vessels themselves. Bacteria typically gain entry through a cut, break, or abrasion. Often red streaks appear, and the painful condition progresses rapidly. Seek immediate medical attention if any of these infections develop.
Contact dermatitis is characterized by itchy, red, inflamed skin after contact with a foreign substance. It is a sort of allergic reaction. When it occurs beneath a compression wrapping or garment, it may be helpful to apply a layer of barrier lotion, such as a dimethicone-based lotion, before applying the dressing.
Lymphedema rubra is a condition frequently mistaken for cellulitis. Skin becomes reddish and inflamed looking, making it appear as if an infection is present. But the condition is actually related to the release of histamine, a protein the immune system releases in response to allergens.
The compound causes local blood vessels to dilate, which causes the redness. Although it behaves somewhat like infection, it will not respond to antibiotic therapy, because it is not caused by any bacteria. It does, however, indicate an inflammatory process, and may eventually lead to the development of tissue fibrosis. It may signal that your lymphedema is not being controlled as well as it should be.
Intertrigo is a whitish discoloration of the skin, typically forming in areas such as the skin between the toes on an affected foot, or within skin folds elsewhere. It’s related to moisture buildup in the area, and could eventually lead to fungal or bacterial infection. It should be controlled through careful washing and drying of the affected area.
Folliculitis occurs when hair follicles become irritated and/or infected. Tiny red bumps around the hair follicles may develop. As with other lymphedema-related skin conditions, it is best treated — or prevented — through meticulous care of the skin. This means careful washing and thorough drying of affected areas, and perhaps the judicious use of barrier lotions.