Taking care of your skin with lymphedema

Human skin has three main layers. The outermost layer is the epidermis, the middle layer is the dermis, and the deepest layer is the hypodermis. The epidermis acts as armor, protecting the body from bacteria, chemicals, and damaging ultraviolet radiation. 

When an injury or opening in the skin occurs, bacteria and viruses can enter quickly into the body, causing an increased risk for illness and infection. It’s important to know that infections and lymphedema are closely connected. Having increased blood or lymphatic fluid in an area increases the risk of infection in the body and if someone gets an infection they are at a higher risk of developing lymphedema. If an individual has lymphedema, taking care of the skin is the first form of defense when it comes to avoiding infections.

Here are the best healthy skin care habits to include in your daily routine.   

Moisturize Daily

Moisturizers and lotions create a barrier and another layer of protection from harsh climates, such as cold, dry air. They also help keep the skin well-hydrated, allowing it to hold more water to avoid skin breakdown. Dry and cracked skin can lead to openings in the skin, which increases the risk of infection. It’s best to look for lotions and moisturizers that don’t have perfumes to avoid irritating or drying out the skin. Moisturizer or cream should be applied at least 1x per day. Be sure to allow the lotion and skin to fully dry before putting on garments to avoid breaking down the fabric and make it easier to get garments on.

Sun Protection

Sunburns cause immediate inflammation, while repeated ultraviolet radiation causes long-term damage to the skin. Getting a sunburn will cause inflammation and swelling for 3-5 days. For more significant burns, blistering and opening in the skin may occur, causing a portal for bacteria. 

Even without sunburns, ultraviolet rays from the sun break down collagen and elastin in the skin, which help keep the skin firm and elastic. When these fibers break down over time, the skin may become loose and thin, making it more fragile and vulnerable to cuts and openings.  

It’s recommended to use sunscreen with an SPF of 30 or greater and reapply every two hours when someone is outdoors. When able, wearing clothing to cover the skin and wearing a hat will assist in protecting it from the sun even more.

Avoid Cuts and Scratches

Cuts and scratches place the skin in the most vulnerable situation. The goal is always to avoid or minimize the number of skin openings. Injuries and cuts to the skin will open up the pathway for bacteria and pathogens, but the body’s natural healing response will send more blood flow and blood cells to the region. This will cause more fluid and swelling to the area, which can flare up the lymphatic system and worsen symptoms of lymphedema. 

Look at doing small things like walking carefully in the winter on the ice, avoiding throw rugs in the home, and wearing shoes with good support to prevent injuries or falls. To avoid cuts and scratches, wear thick gloves while gardening or doing various household chores and trim your pet’s nails whenever you are able.

Scratches, cuts, and injuries are going to be inevitable. If someone gets a cut or scrape, it’s essential to clean it well. The best way to do that is to wash the area with soap and water to clean out dirt and irritants. Then, apply an antiseptic cream or gel over it, and cover it with a sterile bandage. This will help minimize the risk of infection until the skin is fully healed. 

Nail Care

Nails provide a barrier, along with the skin. The nail and nail beds are a common location for infections to occur. Infections at the nails include fungal, bacterial, and warts. These infections often happen due to poor nail care at a salon or home.

When cutting the nails, make sure to avoid cutting them too short. Avoid ingrown nails, trimming cuticles short, and don’t forget to moisturize well to avoid cracked and split skin. When choosing to go to a salon, selecting a trusted location that uses sterilized and clean tools is crucial. Communication with the professional is important to help them be more cautious when providing the nail service. 

Keep Edema Controlled

Edema and lymphatic fluid can cause damage to the skin from the inside out. The fluid needs a place to move to, but if the swelling can’t move quickly through the lymphatic vessels or veins and out of the area, it will potentially make its way out of the skin. Significant edema and swelling may increase the risk of skin breakdown and wounds. These wounds tend to be slow to heal and produce lymphatic fluid seeping and drainage. The best way to stop this and fully heal the wounds is to get the swelling down with support from a wound therapist and certified lymphedema therapist, who will provide wound care and compression for healing and recovery.

Swelling in an area will also cause the skin to expand and stretch. When this happens, it damages the skin. The damaged skin will frequently shed, which causes increased dryness and a higher risk of more skin openings and infection.

For both of these concerns, minimizing swelling and edema is the best way to prevent this skin damage. Lymphedema and swelling can be well-managed with daily compression, exercise, and lymphatic drainage with a pneumatic compression device. AIROS Medical’s compression therapy products are user-friendly and provide sequential gradient compression to mimic manual lymphatic drainage. You can learn more about AIROS Medical products HERE.

Complete Routine Skin Checks

Skin changes with aging, lymphedema symptom progression, and also within each climate season. Getting to know your skin and doing regular skin checks can help you understand what something is new or of concern. Start with a weekly check while putting lotion on. Be sure to use a mirror for hard-to-see areas. Focus on the color and texture of the skin and look for openings, cuts, or other areas of concern.

If someone goes for a hike or participates in another outdoor activity, it’s a great time to repeat a skin check. If outdoors, use insect repellent to avoid bug bites. If a bug bite occurs, monitor the area for openings to care for and avoid scratching to minimize the risk of inflammation and wounds. 

Compression bandages, garments, and tight clothing or jewelry can cause skin irritation if they do not fit properly. Routine skin checks after taking items off will help identify areas of the body that may have been affected by a tourniquet from the clothing or compression. If this is found, pad the area well or avoid wearing it again and work with a certified lymphedema therapist for support and guidance on proper fit.

If there are any changes in lymphedema symptoms or pain levels, completing a skin check will also help monitor for infections or cellulitis. A rash, redness, severe pain, new swelling, and fever or flu-like symptoms can be signs of infection. If any of these skin changes or other symptoms occur, then immediately reach out to a physician or doctor.

References:

Coates M, Blanchard S, MacLeod AS. Innate antimicrobial immunity in the skin: A protective barrier against bacteria, viruses, and fungi. PLoS Pathog. 2018;14(12):e1007353. Published 2018 Dec 6. doi:10.1371/journal.ppat.1007353

Grada, A. A., & Phillips, T. J. (2017). Lymphedema: pathophysiology and clinical manifestations. Journal of the American Academy of Dermatology, 77(6), 1009-1020.

Fife, C. E., Farrow, W., Hebert, A. A., Armer, N. C., Stewart, B. R., Cormier, J. N., & Armer, J. M. (2017). Skin and wound care in lymphedema patients: a taxonomy, primer, and literature review. Advances in skin & wound care, 30(7), 305-318.



Kelly Sturm
Author:
Kelly Sturm

Kelly Sturm is a physical therapist, Certified Lymphedema Therapist, and one of the first national board-certified oncology clinical specialists in the United States. She serves as an instructor at Concordia University’s Physical Therapy Program and a guest speaker at various conferences, programs, and community groups.

Close