Skin care for lymphoedema

If you have lymphoedema, it is important to prevent infections that could make lymphoedema worse. Some general tips are:

  • Keep skin clean and use soap-free cleansers.
  • Moisturise well.
  • Avoid getting cuts and scratches, and treat any immediately by washing and applying antiseptic.
  • Avoid exposing the area to heat and sun, which can cause inflammation.
  • Use insect repellent.

If you have lymphoedema of the hand/arm or foot/leg, avoid activities that could cause muscle strain in the area, for example certain sports or carrying heavy bags. You should also avoid wearing tight clothes, jewellery or shoes.

It’s important to recognise the first signs of infection. If an area of skin becomes red, hot and painful, contact your GP immediately. This could be a sign of cellulitis, an infection that needs treatment with antibiotics. There is specific guidance on using antibiotics for cellulitis in people with lymphoedema.

Sometimes, the skin can break and lymph can leak from it. This is called lymphorroea. If this happens, contact your lymphoedema specialist. They will try to stop the leaking and help you prevent further infection.

Skin care

Looking after and protecting your skin is a very important way of preventing injury and infection. Any break in the skin can make you more likely to get an infection there.

Lymphoedema can cause your skin to become dry and itchy, making cracks and breaks more likely. This can increase the risk of infection but can usually be prevented by moisturising often. You can buy moisturising creams from your local chemist or get them on prescription from your doctor. Your lymphoedema specialist can suggest which creams might be best for you.

Reduce the risk of infection

Here’s some advice about reducing the risk of infection if you have, or are at risk of, lymphoedema:

  • Keep your skin clean and dry. Use soap-free cleansers that don’t dry your skin.
  • Wash with warm water every day. Carefully dry in between fingers or toes of the limb that is at risk of lymphoedema, to prevent fungal infections.
  • Moisturise gently every day with unperfumed cream or oil to help your skin stay in good condition.
  • When applying moisturiser, the last stroke should be downwards (in the direction of hair growth) to prevent the moisturiser blocking the hair follicles (folliculitis).
  • Treat even small grazes and cuts straight away. Wash and dry the area thoroughly, apply antiseptic cream and cover, if necessary.
  • See your GP straight away if you develop any signs of infection in the affected area (see below).
  • Do not get a tattoo on the limb that is affected or at risk.
  • If possible, avoid having needles put into your affected hand/arm or foot/leg when you have blood taken, injections, vaccinations, a drip (infusion), or acupuncture. Although there’s no strong medical evidence to support this, most lymphoedema experts think it’s a wise precaution to take to reduce the risk of infection.

It may be helpful to wear a lymphoedema alert bracelet to remind healthcare professionals that the affected arm should not be used for needles. These are available from the Lymphoedema Support Network (LSN).

Protect yourself from inflammation

Here’s some advice about protecting your skin if you have, or are at risk of, lymphoedema:

  • Protect the skin on the affected area from the sun by covering up with clothes or wearing sun cream with a sun protection factor (SPF) 50. Never use a sunbed.
  • Use insect repellent to prevent insect bites as they can lead to inflammation and infection. Speak to your pharmacist about the best product. You need a repellent with at least 50% DEET. This is the active ingredient in insect repellent. If you’re stung on, or near, the affected area, see your GP for advice.
  • Avoid using saunas, hot tubs and steam rooms, and try not to sit too close to a fire or other heat source.
  • To avoid scalding yourself, always test the water’s temperature before you have a bath and shower.
  • Be careful when playing sports that may result in an injury to the arm or leg with, or at risk of, lymphoedema.

Lymphoedema of the hand or arm

As well as the general advice above, here are some specific tips for people with, or at risk of, lymphoedema of the hand or arm:

  • Avoid cuts or scratches by wearing gloves for household tasks, such as washing up, DIY, or gardening. Be careful when handling any pets that might scratch. Wearing long sleeves, as well as gloves, will give extra protection when doing some of these activities.
  • Use your unaffected hand to remove food from the freezer.
  • Avoid burns by using oven gloves or pot holders and by wearing long sleeves when cooking and baking.
  • Avoid limiting the blood supply to the affected area, such as having your blood pressure taken or wearing tight elasticated bracelets.
  • Use nail clippers instead of scissors to reduce the risk of cutting your skin and don’t push back or cut your cuticles.
  • Never use a razor blade to remove unwanted underarm hair. Use a well-maintained electric shaver to avoid getting cuts.
  • Don’t use waxing or sugaring to remove unwanted hair.
  • Hair removal creams can be harsh on the skin so be careful and try a small test patch before using them on larger areas.
  • Avoid wearing jewellery or clothes that could restrict the flow of fluid, such as tight bra straps, tops with tight armholes, or rings, watches or bracelets that feel tight. A well-fitted bra with a wide shoulder strap and deep sides can help support the breasts and feel more comfortable.
  • Avoid deep tissue massage on the affected area.
  • Don’t carry anything heavy, such as bags or shopping, with the affected arm. Muscle strain can make the swelling worse.
  • Avoid everyday activities that use the arm for long periods, such as using a vacuum cleaner, or gripping, such as ironing or driving.
  • Rest frequently and do some exercises to stretch and relax the muscles to lessen the strain.

Lymphoedema of the foot or leg

Here are some specific tips for people with, or at risk of, lymphoedema of the foot or leg:

  • Wear well-fitting footwear to protect your feet and to avoid getting blisters.
  • Don’t walk around barefoot in case you step on something or stub your toe, causing damage to the skin.
  • Use nail clippers instead of scissors to cut your nails to reduce the risk of cutting your skin.
  • See a chiropodist (a foot specialist) for foot and nail care if you need extra help, and let them know you have, or are at risk of, lymphoedema.
  • Wash and dry between your toes carefully and use anti-fungal powder to prevent or treat signs of athlete’s foot such as peeling, itchy skin.
  • Wear long trousers to protect your legs when you’re gardening or doing DIY or household tasks.
  • Never use a razor blade to remove unwanted leg hair.
  • Use a well-maintained electric shaver to avoid getting cuts.
  • Don’t use waxing or sugaring to remove unwanted hair. Hair removal creams can be harsh on the skin so be careful and try a small patch test before using them on larger areas.
  • Avoid deep tissue massage of the affected area.
  • Avoid tight clothing around the groin area. Also avoid wearing ankle bracelets or toe rings that can become too tight.
  • Avoid standing in one position for a long period of time.

Recognising infection

It’s important to know the signs of an infection. Getting an infection treated as soon as possible puts less stress on the lymphatic system and can prevent lymphoedema from getting worse.

If you develop an infection in the skin (cellulitis), the area may become:

  • red and hot
  • painful
  • more swollen.

You may also:

  • have red streaks going up or down from the infected area
  • have a high temperature (fever)
  • feel generally unwell (like you’re coming down with the flu)
  • lose your appetite.

If you have any of these signs, contact your GP straight away. They will usually prescribe a course of antibiotics, which you should start immediately – see below. If it happens over the weekend, don’t wait to see your GP. Go to your local A&E department. You should also contact your lymphoedema specialist, who will usually advise you to stop all lymphoedema treatment.

Don’t wear any compression garments if they feel uncomfortable, and rest the swollen area in a comfortable position with the whole limb supported by a pillow.

Guidance on the use of antibiotics

In the UK there is guidance for healthcare professionals on using antibiotics to treat cellulitis when you have lymphoedema. The guidance is written by a group of specialist doctors and reviewed every year. It’s important your GP follows this guidance when prescribing antibiotics for lymphoedema.

It’s called the consensus document on the management of cellulitis in lymphoedema. It’s available from the British Lymphology Society.

The guidance says that someone with lymphoedema who develops cellulitis should start taking antibiotics as soon as possible. The antibiotics should be taken for two weeks (14 days) as prescribed, until all signs of infection have gone.

It may also be useful to keep antibiotics with you at home or to take antibiotics with you when you travel abroad. You can discuss this with your GP or lymphoedema specialist.

The antibiotics suggested in the document are:

  • amoxicillin and/or flucloxacillin
  • clarithromycin or erythromycin, if you’re unable to take penicillin
  • clindamycin, if the infection isn’t better after 48 hours.

It’s also important to rest and keep the affected area raised. Compression garments may need to be removed if infection is severe. You may need pain relief from your doctor.

Some people with cellulitis need to be admitted to hospital to be given antibiotics into a vein (intravenous treatment). This normally happens when cellulitis is more severe or becomes worse despite having antibiotics at home.

Treating lymph leaking from the skin (lymphorroea)

Lymphorroea happens occasionally when:

  • an area is very swollen
  • the skin is very dry
  • the area of swelling is difficult to treat, for example the genital area
  • there is a break in the skin
  • in some people, a blister filled with lymph fluid appears on the surface of the skin. It can break and the fluid can leak from it.

It’s important to take very good care of your skin. If you have lymphorroea, keep the area clean. The broken skin can easily cause an infection, which can cause cellulitis.

You should see a lymphoedema specialist as soon as possible if you have lymphorroea, so that they can try to stop the skin from leaking. In some cases they may refer you for further treatment by a skin doctor (dermatologist).

The specialist can show you ways of managing lymphorroea at home. You may also benefit from having light bandaging to reduce the swelling in an area that is difficult to manage with a compression garment.

What you can do while waiting to see a specialist:

  • Keep the skin clean and observe for signs of infection (see above).
  • Apply moisturiser around the area that is leaking.
  • Lift your limb when you can – raise an arm to the level of the shoulder or a leg to the level of the hip.
  • Regularly apply a clean, dry dressing to the area. Do not tape it to the skin; gently hold it in place with a soft bandage. Do not apply a lymphoedema bandage unless you’ve been shown how to do it.

Lymphorroea can be distressing and upsetting but specialist help and support can make a real difference. We also have more information about body image.