Caring for your skin is important when you have lymphoedema. You can do several things to protect it, and there are ways to reduce your risk of infection.
Why you need to care for your skin
When you have lymphoedema you need to look after your skin because any injury or infection can make the swelling worse.
This is because injury or infection can cause more damage to the lymphatic system in the area.
People with skin conditions such as eczema or psoriasis might need to see a doctor who specialises in skin conditions (a dermatologist). Any skin breaks can make you more likely to get an infection. Keeping your skin healthy, unbroken and well moisturised helps to prevent this.
Looking after your skin
You can do a number of things to help protect your skin and lower your risk of infection or injury.
- Keep your skin clean and dry – use a soap substitute such as aqueous cream, Oilatum or Neutrogena soap bars or an E45 wash
- Moisturise your skin at least once a day
- Clean cuts or grazes straight away with clean water, then put an antiseptic cream on and cover the area
- Protect your skin from the sun by wearing a high factor sun cream or cover up with clothes
- Use an insect repellent containing at least 50% DEET– if you're bitten or stung, try not to scratch and use antihistamine cream
- Avoid hot baths, saunas and steam rooms because this can increase swelling
- Avoid extremes of temperature that can dry your skin – including hot, cold or windy weather
- Don’t wear tight clothing or jewellery
- Avoid sitting or standing for long periods of time
- Avoid having injections, blood taken, or your blood pressure checked on the affected arm – there is little evidence to show that this increases your risk of swelling or making it worse, but doctors advise this just in case
Moisturising your skin
To keep your skin moist, you need to use a moisturiser (emollient). Emollients help to stop your skin losing water. They do this by creating a protective layer.
There are different types of emollients, including bath oils, soap substitutes and moisturisers. You can get Diprobase and E45 from your chemist. Check with your nurse that any moisturisers you like to use are suitable. Avoid perfumed body lotions because they can dry your skin.
You need to moisturise your skin every day. How you do this and what you use depends on the condition of your skin. To stop moisturising cream clogging your hair follicles, apply the cream with downward strokes.
How to moisturise different types of skin
If your skin is in good condition, you need to use a moisturiser that you can apply easily. This can be a cream or a lotion. It will help to keep your skin hydrated.
If your skin is dry and flaky, you need to moisturise more often or use a moisturiser that is thicker and greasier. This helps to stop further loss of moisture.
If your skin has become scaly, you need to wash it with a moisturising soap substitute and then moisturise afterwards with a thicker greasy moisturiser. This helps to soften the scaly areas so that you can remove them easily.
You might need to put the cream on twice a day. It helps to put it on before you go to bed at night, so that it has time to absorb overnight. Then in the morning you can clean and moisturise your skin before putting on your compression garment.
Tips to help lower your risk of infection and injury
These tips can help to reduce your risk of infection or injury.
- Protect your hands from cuts and scratches when you’re doing household jobs such as washing up, gardening or DIY
- With arm lymphoedema, wear oven gloves and long sleeves to avoid burns when getting things in and out of the oven
- Be careful to avoid scratches when handling pets – clean the area straight away if they scratch you
- Don’t use a wet razor or waxing to remove hair – you can use a clean and well maintained electric razor or hair removing cream
- Be careful when cutting your nails, and use nail clippers – if it’s difficult to cut your toenails, see a chiropodist regularly
- Wear well fitting shoes and avoid going barefoot if you have lymphoedema of the leg – this lowers your risk of blisters or injuring your feet
- Wash and dry your feet thoroughly, including between your toes – if you have had fungal infections before, you might need to use athelete’s foot powder to prevent another one
- Look out for any thickening of the skin, changes in colour, and any blisters or spots – contact your lymphoedema specialist if you have these
First signs of infection
It is important to know the first signs of infection so that you can seek treatment as soon as possible. The first signs of infection are:
- reddening of the skin – this might start in one area and get larger, include the whole limb or cause red lines
Other symptoms include:
- a high temperature
- flu like symptoms (such as aching limbs and tiredness)
- generally feeling unwell
Infection in people with lymphoedema can cause inflammation (cellulitis) or an acute inflammatory episode (AIE).
Your doctor will prescribe antibiotics. You might need to have them into your bloodstream (intravenously) at first, to get the infection under control. Then you can take them as tablets or capsules.
The most commonly used types of antibiotics are amoxicillin or flucloxacillin. If you are allergic to penicillin, your doctor or specialist nurse may prescribe clindamycin.
Having several infections within a short time might mean you need to take antibiotics each day, to prevent further infections. You may need to take them for up to 2 years.
Sometimes lymph fluid can leak on to the surface of the skin. This is called lymphorrhoea (pronounced lim-for-ree-a). The fluid is straw coloured.
It can happen if you scratch the skin. It can also happen if you hurt the area when the skin has become scaly or when the area has become swollen quickly.