Good skin care is a vital part of Lymphedema management, yet many people are not sure exactly what’s involved in properly caring for lymphie skin. Lymphedema skin care differs slightly to that of normal skin care because our skin is a lot more reactive and sensitive to products and trauma than those who have a proper functioning lymphatic system. Maintaining our skin’s integrity is an important basic step in minimising the risk of infection.
Skin is the body’s biggest organ and is the first line of defence in preventing toxic substances and bacteria from entering into our systems. Any little break in the skin can provide an entry point for bacteria, which flourish in the protein-rich fluid that builds up in our limbs and creates swelling. Therefore, it’s important that we all take a few extra steps to ensuring that we keep our skin healthy, hydrated and free from potential infection hazards!
1Protect your hands and feet
As nice as it can be to walk barefoot in the grass, it does pose an infection risk to lymphie limbs if you happen to stand on a sharp piece of wood, a thorn or an insect. It’s a good idea to always protect your feet by wearing proper footwear outside, like enclosed shoes as they protect the whole foot. If you prefer something more open, find a shoe with a sole that is thick enough to stop anything from piercing through the bottom and going into your foot (we speak from experience!). Also, make sure that your shoes fit well and don’t cause blisters.
Upper limb lymphies should always wear gloves while performing manual labour (eg: gardening or washing the dishes) as they protect the hands from bacteria, harsh chemicals and hot water. Make sure the gloves are durable and tear resistant if using outdoors. If you struggle with sweaty hands, put a pair of thin cotton gloves under rubber gloves to soak up the extra moisture. Long sleeve tops are also a good idea if working outside in the garden as they will protect your arms from anything sharp.
2Be aware of sharp household objects
Everyday household items that we normally don’t consider as ‘hazardous’ can become a lymphie’s worst nightmare when they accidentally come into contact with tender skin. Things like sewing objects (pins, needles, scissors) can increase the risk of infection if they pierce the skin, so wear a thimble when sewing. Kitchen tools like sharp knives, cheese graters and cutlery should be used with diligence and properly stored (with covers) to avoid accidentally slicing lymphie fingers!
3Slip, Slop, Slap! Don’t get sunburnt!
Sunburn can be particularly painful and dangerous for lymphie limbs. In order to heal and repair the burnt skin, our bodies work by increasing blood flow to the area, which subsequently increases the amount of interstitial fluid in the damaged area. In a healthy person with a normal functioning lymphatic system, this is not a problem. Their lymphatic systems are able to evacuate this excess fluid at a faster rate. But for someone with lymphedema, this excess fluid can increase swelling and be very painful.
Compression garments do not protect your skin from harmful UV rays, so protect your skin by wearing high-factor suncream (at least SPF 30) and avoid sitting in direct sunlight if possible. When in the sun, protect your limb with either loose clothing, an umbrella or cover it with a towel (if you are laying on the beach).
4Wash your skin with pH neutral products
When selecting skin care products, whether it’s to wash or moisturise with, it’s important that we choose the correct type of liquids and lotions that will not further damage and dry out sensitive lymphie skin.
When it comes to showering and washing our skin, it’s best to use pH neutral soaps and natural products that don’t contain preservatives or perfumes. Ordinary soaps from the supermarket contain detergents and strip the skin of moisture by disrupting the acid mantle (a slightly acidic, naturally secreted layer of oils and amino acids that helps protect the skin). These products jeopardise the skin’s barrier function and strip them of natural oils and moisture- leaving the skin dry, itchy and irritated. Look for natural products that have been enhanced with natural fats and oils, that don’t lather and bubble too much, as they will better protect your skin’s natural integrity!
5Ditch the razor!
Shaving is the cheapest and quickest way to remove unwanted hair but it also takes the prize for causing the most skin irritations and infections! Shaving creates micro tears in the skin which can allow bacteria to go directly into your skin, heightening the risk for infections. Most specialists will recommend that we ditch classic razor blades and instead use either wax, hair removal creams or electric shavers. These tend to be less ‘risky’ options than using a razor blade as they inflict less trauma and reduce the chances of cutting the skin.
If you really need to use a razor blade, there are a few important steps you should follow to ensure smooth shaving. Firstly, always use a sharp blade that is new and clean. Warm the skin and hair to be removed with water or a face cloth (this softens the area) and use a good quality shaving cream or gel. Most importantly, shave in the direction of hair growth and not against it, as this can cause some major irritations to the skin. These days, there are plenty of shaving creams on the market made from natural ingredients that are skin friendly, which is perfect for sensitive skin folk like us!
6Drink more water
Keeping hydrated ensures that your lymphatic system has the nourishment it needs to detoxify and evacuate impurities. Dehydration occurs when there’s a higher loss of water than intake in the body. This happens naturally through things like sweating and heat exposure and we generally replace these lost fluids with the water we drink or food we eat. However, if we lose too much fluid, we become dehydrated and our bodies cannot perform metabolic functions properly (like lymphatic drainage). Waste and bacteria get stuck, protein builds up in our tissues and our immune system struggles to cope. In cases of Lymphedema, dehydration can actually increase swelling as our bodies retain water when dehydrated!
Men should be drinking approximately 3.7 litres of liquids per day and 2.7 litres for women. So fill up your water bottles and get sipping!
7Moisturise and exfoliate your skin regularly
Keeping your skin hydrated from the outside is very important in preventing dryness and cracks, which are zones for infection. For people whose skin is in good condition, lotions should be applied at night to maintain skin integrity. For people whose skin is very dry, flaky or rough and scaly, it is recommended to moisturise with emollients twice per day.
Exfoliating your skin with softly constructed loofahs, body mitts or skin sponges can help shed dead skin cells and stimulate circulation. Always apply moisturiser after exfoliating to hydrate the skin. Just note that emollient products may damage compression garments so make sure they are well absorbed before donning.
8Keep your skin dry and free from moisture
Prolonged moisture and warmth on the skin make a wonderful breeding ground for fungal infections. When our skin is exposed to large amounts of moisture (like through sweating or not drying ourselves properly after showering), the skin will soften and wrinkle, which can lead to breaks in the epidermis. Bacteria thrive in these conditions, particularly in spots like in between the toes and in skin folds that are in contact with each other. These fungal infections can easily turn into cellulitis, so it’s best to avoid them by drying well in between digits after showering, making sure skin fold are dry and clean, wearing fresh compression garments and changing them regularly. Also, don’t be afraid to let your skin breathe in the open air without compression garments on them for short periods of time. Do this at a time where you are resting (eg: legs up, not walking!) so that you don’t compromise your condition and make swelling worse.
If you do happen to get an infection, which can happen to even the most vigilant lymphies, use an antifungal cream, powder or tablets (consult your GP or pharmacist for the best treatment). Consult a dermatologist if it doesn’t clear up within 6 weeks of treatment.
9Protect against insect bites and animal scratches
It happens from time to time that our beloved pet accidentally attacks us with too much love and we receive a scratch or (love!) bite from them, or we get bitten by a mosquito or bee in the garden, causing a little rush of panic in our lymphie brains. These things just happen sometimes, despite our best efforts to avoid them. So to help minimise the risk, it’s a good idea to use repellent sprays when in mosquito territory and treat any bites you might receive with antiseptics and/or antihistamines. Try to not scratch any bites you get as this will only cause more inflammation in the area and can lead to an open wound. Clip your pet’s nails short, or wear long sleeve tops when holding them.
10Avoid overheating yourself
Remember those days of relaxing in a warm jacuzzi with a glass of red wine? Well sorry to break it to you, but those days are over thanks to Lymphedema! Overheating your skin is a big no-no for people with Lymphedema, as heat expands blood vessels under the skin and can make swelling worse. Things like saunas, steam rooms, jacuzzis, sun beds, electric blankets and hot baths can all contribute to this problem so it’s best to avoid them.
Our skin also contains certain proteins and fats that create a protective barrier from harsh outside environments. Taking frequent hot showers can disrupt this protective layer and lead to dry, itchy skin and increase the risk of getting infections. As a general rule, water temperatures should be no hotter than 38 degrees Celsius.
11Say NO to needles!
Do not, whenever possible, allow needles to be inserted into your swollen limb (e.g. blood samples, immunisations, acupuncture). Also, do not have your blood pressure taken on your swollen limb. Make sure your caregivers are aware of your Lymphedema and the importance of not piercing the affected limb.
12Rethink those manicures and pedicures (insert sad face)
A pedicure or manicure is a great way to pamper yourself and make your nails look beautiful, however, there are many risks associated with nail trimming, cuticle cutting and foot soaking at a nail salon. Bacteria and fungal infections can be introduced from soaking your feet in unclean tubs that have not been properly sterilized in between clients, particularly if you have a cut in your skin. The potential for getting ingrown toenails and nicks or cuts is also higher. The solution here is simple: it’s much safer to do it yourself at home with your own tools that have been properly sterilised and cleaned. Keep finger and toenails short using clippers, not scissors, and cut them straight across (as following the nail curve can cause ingrown nails). Do not cut cuticles! They are very important for nail health and play a role in protecting our fingernails from infections, so push back any excess cuticle growth with a small wooden stick.
If you have problems reaching your feet and need assistance, or simply just prefer that someone else does the work for you, a medical pedicurist is a great alternative to the salon. Medical Pedicurists are highly trained in nail care for medical conditions, disorders, and deformities of the feet and hands so they can make educated recommendations and treatments for your nails that are safer than a regular nail salon.
What should I do if I cut or graze my skin?
Sometimes, despite our best intentions to follow all of the advice above, we end up with a skin injury that needs to be treated. For any cuts or grazes, wash and clean the skin immediately using flowing water and antiseptic wash (if you have some). Try the area with a clean towel and apply an antiseptic spray or lotion. If needed, dress the wound with a sterile band-aid. Remember that wounds need fresh air to heal properly, so don’t keep them covered for too long.
Always have a medical alert card, or bracelet with you wherever you go, so that caregivers are aware of your condition in an emergency situation. Also, if your limb becomes hot, red or more swollen, contact your GP immediately because this can be a sign of infection and you might need an urgent course of antibiotics.
International Lymphoedema Framework: Best Practice for the Management of Lymphoedema. International consensus. London: MEP Ltd, 2006.
Lymphedema People: Skin Care
Lymphoedema Support Network: Skin Care for People with Lymphoedema