Infection Prevention and Skin Care

John Fuller Beckwith3/14/2024

Infection prevention is the most important thing you can do for yourself if you have lymphedema. Infection is an increased risk in persons with lymphedema due to two factors: first is that impaired lymph transport means there is an impaired immune response in the body area affected by the impaired lymph flow; second is that the accumulation of stagnant, protein-rich fluid seen in lymphedema creates a rich environment for the spread of bacteria. Also, each additional infection further impairs lymph flow, increasing future risks. Fortunately daily attention to your skin will greatly reduce the risk of infection.

Meticulous Skin and Nail Care

This is the simplest and most effective way to help prevent infection. It can be easily incorporated into your daily routine. Inspect your skin closely, looking for signs of infection or skin injury. Wash thoroughly the entire skin surface. You can moderately scrub firm tissues and gently cleanse softer, more tender areas. Rinse well, then dry the skin well, especially between the toes/fingers and in any skin folds. Use a good, low pH lotion (generally 4.5-6.0) to moisturize the skin. You may consider a skin powder to address itching and more fragile, moist skin areas.

Avoiding Skin Injury

The primary function of your skin is to protect the integrity of your body, hence in medical terminology skin is called the Integument. Most skin infections are caused by an infectious agent entering the body through a portal or break in the skin. You can avoid most infections by taking care to avoid skin injury. Therefore, if you have lymphedema, it is advised that you: wear gloves when working outdoors, avoid sunburns, avoid pet scratches and insect bites, wear long sleeves or pants, keep feet covered, avoid injuries in the kitchen such as burns or cuts from sharp instruments, use electric rather than blade razors for shaving, avoid injections and blood draws in the at-risk limb, take care during nail care to avoid cutting the skin.

If You Injure the Skin

Even with our best intentions, injuries can occur. This does not mean you will develop an infection. The key, as with most things, is early management: wash affected area with simple soap and water, dry well, apply a small amount of topical antibiotic, cover well. Inspect daily for redness and pain, as well as repeating above steps daily. If it does not resolve steadily, but rather develops redness and pain, seek medical attention.

Signs of Infection

The cardinal signs of infection are redness, localized swelling, pain and heat. Two other important signs may be fever and red streaks on the limb. The redness may start out fairly small and have well-defined, map-like borders, but may also present in a more blotchy appearance. Redness that increases in size should be a concern. One cardinal sign presenting alone is not likely to be an infection, but when pain and increased temperature of the skin are combined with redness there is a strong risk of infection. Fever and red streaks are signs that, with the other signs, an infection has spread beyond local tissues and immediate medical attention is indicated.

What To Do if You Think You Have an Infection

Note the signs of infection above. When in doubt, always seek medical attention. If you suspect you have an infection, call one of your physicians to ask for an appointment that day. If they are unable to see you that day, then you must go to an urgent care center or to the emergency room. The important concern at this point is to treat the potential infection as soon as possible. Because untreated infections can progress quickly, it is unwise to let too much time pass before receiving medical attention. All infections are dangerous and should be a first priority.

Good skin care is relatively simple and not time consuming. With a little practice it will become second nature and you can feel confident you will avoid serious infection. If you ever have any questions, please feel free to call your lymphedema specialist.