Lymphedema Related Infections
Infections are dangerous to anyone, but especially for those with lymphedema. Make sure to clean all cuts, scrapes, and insect bites and keep a bandage on them. It’s a good idea to keep a small first aid kit with you when you travel or are outdoors.
Types of Infections
There are several types of infections that you may experience.
- Fungal infections: The two most common places for fungal infections are between skin folds and between the toes. Skin folds can sometimes have moisture buildup from sweat. This can cause the skin to breakdown and lead to fungal growth. Fungal infections can also increase risk of bacterial infections, which delays wound healing. It is very important to keep these skin folds and the space between your toes clean and dry.
- Erysipelas (bacterial infections): Erysipelas is a superficial infection of the inner layer of your skin. With Erysipelas, the infected area is generally raised above the level of the surrounding skin. With this type of infection, you will notice redness, swelling, and warmth that will come on quite quickly. You may also have a fever and chills. In general, erysipelas is more often seen in children and the elderly.
- Cellulitis: Cellulitis is an infection involving the deeper layers of your skin. Similar to erysipelas, cellulitis presents with redness warmth, and edema. These Infections can be mild and respond to oral antibiotics, or severe and require IV antibiotics and hospitalization. Often times with lymphedema, these infections tend to be more severe and require more intensive treatment.
- Lymphangitis: Lymphangitis is an inflammation of the lymph vessels. These infections generally occur when bacteria that enters the body through an open wound or cut travels into your lymphatic vessels. With lymphangitis, you will see red streaks on the skin. Lymphangitis requires immediate treatment with antibiotics.
Other conditions that could be confused with infections
- Contact Dermatitis: Generaly itchy, red, inflamed skin caused when your skin develops an allergic reaction after being exposed to a foreign substance. Contact dermatitis can occur under compression.
- Acute Gout: an intensely painful arthritis condition that usually starts by affecting a single joint, most frequently the big toe, ankle, or knee. Acute gout can be swollen, red, and very painful, and look very much like an infection.
- Vasculitis: Inflammation of the blood vessels
- Insect Bite: Insect bites can lead to inflammatory changes with or without infections. Some insects release toxins which can mimic infection.
- Lymphedema Rubra: Lymphedema rubra is redness of the skin that is often mistaken for cellulitis. One way to distinguish lymphedema rubra from a traditional infection is that the redness is very symmetrical, and antibiotics do not help rubra. If you have been on antibiotics for a long time with no improvement, it is possible that you are dealing with lymphedema rubra, and not cellulitis.
- Folliculitis: Folliculitis is an inflammation of the hair follicles (a hair follicle is where the hair enters the skin). It presents with small red dots around the base of the hair follicle. It is commonly caused by irritation, but can be caused by bacteria or even fungal infections. Good skin care hygiene and reducing friction to the area can reduce risk of folliculitis.
- Intertrigo: Intertrigo is caused by moisture and typically occurs between the toes and skin folds. It appears as a white discoloration with a shedding top layer of skin. Treatment consists of washing with a mild soap and drying well. Intertrigo can develop into a fungal or bacterial infection if not treated promptly.
What to do if you think you may have an infection
- Call your clinician immediately or go to the ER for evaluation
- Draw a line around the red area and note the date and time so you can track if it is spreading and if so, how fast. You can also keep track of this in the Infection Tracker section of your diary once you are logged into the LymphCare Community.
- Monitor the area closely. Make sure you check it several times a day until treatment has it under control and improving.
- Stop any MLD. You should stop self-MLD until your clinician instructs you that it is ok to start again. Self-MLD may spread infection and inflammation into you lymphatics and create a more difficult situation to manage.
- Antibiotics. If you have an infection and have lymphedema your clinician may prescribe antibiotics. If you are prone to infections or are planning to travel somewhere far from a hospital, or to another country, it can be a good idea to talk to your doctor about getting a preventative prescription to fill in case you develop a problem and don't have immediate access to a clinician.
- Tell your clinician if you have any increase in your swelling. You may want to follow up with your CLT after the infection has cleared to see if you to come in for treatment.
How to reduce your risk of infection
- Good skin care is very important. Skin should be washed with soap and water. You should use moisturizer to keep your skin soft and hydrated and to reduce risk of skin cracking. In the winter the air is drying and moisturizer is more likely needed. Dry, cracked skin can become an entry point for bacteria and increase infection risk.
- Keep skin folds and toe webbing clean and dry. Some patients use skin barrier creams and/or gauze/clean fabric between skin folds to help wick moisture away from the skin and reduce risk of skin breakdown.
- Keep compression garments and bandages clean.