Skin care for lymphoedema

Skin care is an important part of lymphoedema treatment. If you have lymphoedema or are at risk of it, you are also at risk of a skin infection called cellulitis. Keeping your skin clean and well moisturised can help to protect it. 

There are things you can do to reduce the risk of: 

  • getting cuts and grazes to your skin 
  • getting sunburn or insect bites  
  • being exposed to extreme temperatures. 

Following these tips will help minimise the risk of infection.

It is 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 guidance for doctors 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.

Why skin care is important

It is important to look after and protect your skin to avoid any injury or infection. If you have lymphoedema or are at risk of it, you are also at risk of a skin infection called cellulitis. Good skin care helps reduce this risk.


Tips for keeping your skin in good condition

Lymphoedema can make your skin dry and itchy. This makes cracks and breaks in the skin more likely and increases your risk of infection. You can help your skin stay in good condition by moisturising every day. 

If your skin is in good condition, you can use any moisturiser. If you have dry skin or other skin problems, your lymphoedema specialist can suggest the best creams for you. You can buy moisturising creams from your local chemist. You can also get some on prescription from your doctor. 

When you put on moisturiser, make sure the last stroke is downwards (in the direction of hair growth). This stops the moisturiser blocking hair follicles (folliculitis).

Here are some more things you can do: 

  • Keep your skin clean. Wash with warm water every day. If you have dry skin, use soap-free cleansers.
  • After washing, carefully dry the area. If the lymphoedema is in a limb, make sure you dry in between fingers or toes of the affected limb. 
  • If lymphoedema affects your feet, use surgical spirit or alcohol wipes daily between your toes. This helps prevent athlete’s foot (a fungal infection). You can use anti-fungal powder to treat signs of athlete’s foot, for example having peeling, itchy skin.


Cuts, grazes, burns and bites

You are more likely to get an infection if your skin is broken. It is impossible to avoid all skin injuries. So, if you do get a cut, graze or burn:

  • treat it as soon as you can, even if it is only small
  • wash and dry the area thoroughly
  • put antiseptic cream on it
  • cover if necessary.

If you get an insect bite or sting that is on or near the affected area, try not to scratch it. Scratching may cause more damage to the skin. Using antihistamine cream may help reduce itching. Speak to your GP for advice if the break does not heal, or shows any sign of infection.


Tips for avoiding cuts and grazes

It is impossible to avoid all skin injuries. But there are things that you can do to reduce the risk.

Household tasks

Doing some household tasks can increase your risk of injuring your skin. These include washing up, DIY, gardening or cooking. Depending on where the lymphoedema is, you could wear long sleeves, gloves, or long trousers to help reduce this risk.

Pets

Take care around pets that might scratch. Try to keep them away from the affected area. Or think about clothing or blankets that could protect you.

Removing hair

Be careful removing unwanted hair that is in, or near, the affected area. An electric shaver is the safest way to remove hair. Razor blades, waxing and sugaring can all damage the skin. Some people use hair removal creams, but these can be harsh on the skin. Always test a small area first.

Cutting your nails

Use nail clippers instead of scissors to cut your nails. You are less likely to cut the skin with these. It is also best not to push back or cut your cuticles. Tell your doctor or lymphoedema specialist if you need extra help with the nails on your feet. They can refer you to a foot specialist (chiropodist). Tell the chiropodist that you have lymphoedema, or that you are at risk of it.

Exercise

Exercise can help improve the symptoms of lymphoedema. But some sports can increase your risk of damaging the skin. Your specialist can talk to you about any care you should take for a specific sport. Or they may suggest other sports you can try instead.

Shoes

If you have lymphoedema in a leg, think about what you wear on your feet. It is best to wear shoes that fit well, protect your feet and do not rub. It is safest not to walk around barefoot. This is in case you step on something or stub your toe.


Tips for avoiding burns and bites

Insect repellent

Using a good insect repellent can help to prevent insect bites. Your pharmacist can give you advice about the best one to get. Look for a repellent with at least 50% DEET. This is the active ingredient in insect repellent.

Sunburn

Sunburn can cause dryness and blistering. Try to wear clothes that cover you in the sun. Make sure you use a sun cream with a sun protection factor (SPF) 50. You should not use a sunbed.


Other tips for avoiding skin damage

Lymphoedema alert bracelet

When seeing health professionals, always tell them about your lymphoedema. This is because they may need to give you injections, vaccinations, a drip (infusion), or acupuncture. If you need to have any of these, they should try to avoid putting needles into the affected area. There is no strong medical evidence to say this will increase your risk of getting lymphoedema. But most experts see it as a precaution to reduce the risk of infection. It may be helpful to wear a lymphoedema alert bracelet. This will remind healthcare professionals that they should not use the affected arm for needles. These are available from the Lymphoedema Support Network (LSN)

Tattoos

Talk to your doctor or nurse before getting a tattoo on the area affected by or at risk of lymphoedema.


Tips for avoiding temperature extremes

Extreme temperatures, like being too hot or too cold, can sometimes make swelling worse. Here are some tips for avoiding this:

  • Avoid using saunas, hot tubs and steam rooms.
  • Try not to sit too close to a fire or other heat source.
  • Always test the temperature of the water before you have a bath or shower, to avoid scalding yourself.


Managing problems caused by lymphoedema

Recognising infection

It is important to know the signs of an infection. Getting treatment for an infection as soon as possible puts less stress on the lymphatic system. This can stop lymphoedema getting worse.

If you get 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 are getting 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 straightaway. If it happens over the weekend, do not wait to see your GP. Contact your out of hours GP service – these are different depending on whether you live in England, Scotland, Wales or Northern Ireland. You should also contact your lymphoedema specialist. They will usually tell you to stop all lymphoedema treatment.

Do not wear any compression garments if you have a skin infection and it is painful. Contact your lymphoedema specialist for advice. Rest the swollen area in a comfortable position. For example, you could support the whole limb with a pillow. You should not exercise until the infection has gone.

You should wear your compression garment again as soon as you start feeling better, and it is comfortable. You should still wear it, even if you are still taking antibiotics.

Guidance on using 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 lymphoedema specialists. It is important your GP follows this guidance when prescribing antibiotics for lymphoedema.

The guidance is called the consensus document on the management of cellulitis in lymphoedema. It is available from the British Lymphology Society.

The guidance says that someone with lymphoedema who develops cellulitis, should start taking antibiotics as soon as possible. They should take the antibiotics for at least 2 weeks (14 days) as prescribed, until all signs of infection have gone.

If you have had an infection, it may be useful to keep antibiotics with you at home. You can also take antibiotics with you when you travel abroad. You can discuss this with your GP or lymphoedema specialist.

The consensus document suggests the following antibiotics:

  • Amoxicillin or flucloxacillin
  • Clarithromycin or erythromycin, if you cannot take penicillin
  • Clindamycin, if the infection does not start to get better after 48 hours.

It is also important to rest, and keep the affected area raised. You should remove compression garments if they are painful. You not should wear them until it is comfortable again. You may need pain relief from your doctor.

Some people with cellulitis need to go to hospital to have antibiotics into a vein (intravenous treatment). This normally happens when cellulitis is more severe or becomes worse after taking antibiotics at home.

Treating lymph fluid leaking from the skin (lymphorroea)

Lymphorroea is when lymph fluid leaks from the skin in the affected area. It is not common but can happen 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
  • a blister filled with lymph fluid appears on the surface of the skin and breaks

It is important to take good care of your skin. If you have lymphorroea, keep the area clean. The broken skin can easily cause an infection, such as cellulitis.

You should see a lymphoedema specialist as soon as possible if you have lymphorroea. They will try to stop the skin from leaking.

The specialist can show you ways of managing lymphorroea at home. It may also help you to have some light bandaging. This can reduce 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 look for signs of infection.
  • Apply moisturiser around the area that is leaking.
  • Lift your limb when you can. For example, 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. But do not tape it to the skin. Gently hold it in place with a soft bandage. Only put on a lymphoedema bandage if your lymphoedema specialist has shown you how to do it.

Having lymphorroea can be upsetting, but specialist support can help you. We also have more information about body image that may help.