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Joachim Zuther, Lymphedema Specialist. Read more
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Skin and Nail Care in Lymphedema Management

 

Skin and nail care play an essential role in both prevention of lymphedema in those patients at risk of developing this condition, and in the management of existing lymphedema. Current methods of cancer treatment lower the risk of developing lymphedema. However, if a patient had surgery involving the lymphatic system – a radical mastectomy for example – even many years ago, the risk for developing lymphedema will always be present, even if this patient never had any arm swelling.

Prevention is in the patients’ best interest and a great tool to avoid the onset of lymphedema. The skin is the first line of defense against foreign invaders and is usually impermeable to bacteria and other pathogens. However, any defect in the skin such as burns, chafing, dryness, cuticle injury, cracks, cuts, splinters, and insect bites can present an entry site for pathogens or infectious agents and cause infection.

Patients who already have, or had lymphedema are susceptible to infections of the skin and nails. Lymphedematous tissues are saturated with protein-rich fluid, which serves as an ideal nutrient source for bacteria and other pathogens. Lymphedematous skin also tends to be dry and may become thickened and scaly, which increases the risk of skin cracks and fissures.

The process of inflammation may not only make lymphedema much worse by increasing the swelling, but can also develop into a serious medical crisis. The basic consideration in skin and nail care is therefore the prevention and control of infections, which includes proper cleansing and moisturizing techniques with the goal of maintaining the health and integrity of the skin.

Suitable ointments or lotions formulated for sensitive skin, radiation dermatitis and lymphedema should be applied before the application of lymphedema bandages while the patient is in the decongestive phase of the treatment. Once the limb is decongested and the patient wears compression garments, moisturizing ointments should be applied twice daily.

Ointments, as well as soaps or other skin cleansers used in lymphedema management, should have good moisturizing qualities, contain no fragrances, be hypo-allergenic and should be in either the neutral or acidic range of the pH scale (around pH 5). To identify possible allergic reactions to skin care products, they should be first tested on healthy skin before the initial application to areas affected by lymphedema. Skin care products often used by lymphedema patients include Eucerin, Lymphoderm, Lindi Skin products, Curel and Johnson&Johnson Baby Lotion.

Compression garment too tight and too short

Tight fitting compression sleeves or stockings, as well as materials used in compression bandaging may also cause skin irritation. Some patients may be allergic to a certain material used for compression therapy. This situation can be remedied by switching to other materials.

In mosquito infected areas it is necessary to apply insect repellents to the affected extremity (some moisturizers contain natural repellents) to avoid bites, which are a common cause for infections. To take proper care of mosquito bites and minor injuries, it is advisable to always carry an alcohol swab, antibacterial ointment and a band-aid.

When caring for nails, it is important to keep the risk of infections to a minimum. Finger and toe nails should be kept short using clippers (no scissors), toenails should be cut straight across, and a podiatrist should be consulted to treat and prevent ingrown toe nails. Cuticles on fingers and toes should not be cut but pushed back with a cuticle pusher.
Bacteria between the natural and artificial nails are a common cause for infections; acrylic nails should be avoided.

For an excellent resource regarding all aspects of skin care, to include helpful hints, I would like to refer you to this link: http://www.lymphedemapeople.com/wiki/doku.php?id=skin_care

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19 comments to Skin and Nail Care in Lymphedema Management

  • Great advice! I’ve never felt that acrylic nails were worth the expense and time, and now as a person with lymphedema I have another reason to avoid them. And I will test skin lotions and creams on my unaffected hand before applying them to my lymphedematous hand. Too many times the skin on my hand has broken out because I didn’t test the lotion first.
    Jan

  • Katie Rogers

    How can someone tell what the pH of an off the shelf moisturizer is? Thanks in advance!

  • Cynthia

    Do you believe Aloe Vera would help lymphadematous skin? My toes look a LOT like the ones in the picture in the article, I’ve been dealing with this for 40 years now. Thanks for any advice on moisturizers that may help our skin. :o)

    • Joachim Zuther

      Dear Cynthia: Aloe Vera can certainly be used. Other products frequently used by peole with lymphedema are Lindi Skin products, Lymphoderm and Eucerin.

  • I have bilateral primary lymphedema and have developed what looks like warts growing on most my toes, is there a way for me to get rid of them without risking infection?

  • Cynthia

    I have also found there is a “yellow nail disease” that is associated with lymphadema. When I was 10 my lymphadema “showed up” and shortly thereafter my finger and toenails started turning yellow and became very hard and thick…they also only adhere to the nail bed half way up the nail…they actually get caught on things and will pull back off to the “root” of the nail and will eventually come completely off…

  • Sarah lindsay

    I have post surgical lymphedema in my left leg. The damage to my foot (toes) is extreme. My whole leg is much bigger than the other leg but skin still looks very good considering what its been through however the toes are just awful. I’m considering having some removed. I’m 34 and it would be nice to keep them a bit longer if they can start behaving themselves. I have plantar warts on the top of my toes. They don’t look like warts but thats what the pathology came back as after a minor surgical procedure on one of them last year. Basically at the natural joint in each toe it looks like packman. Most people would never expect that I have this problem because I do such a good job of hiding it. Before this surgery I was a gymnast,runner,long distance rollorblader…very active. This problem…well it sucks! Too moist or too dry creates major issues. There is no fix for lymphedema and the issues that come along with it. You just have to do the best you can with what your working with. Somedays are better than others.

  • [...] Skin Care: Patients who have lymphedema are susceptible to infections of the skin; areas between skin folds or the underside of the breast are particularly prone to skin damage and infections. Edematous areas should be kept clean and dry and suitable ointments or lotions formulated for sensitive skin, radiation dermatitis and lymphedema should be applied. [...]

  • [...] be instructed in self-MLD and encouraged to perform self treatment for at least 20-30 minutes daily.Skin Care: Patients who have lymphedema are susceptible to infections of the skin; areas between skin folds [...]

  • Robbyn Purol

    Ingrown toenails can be minimized by making sure that the cuts on the nail are properly done. Blunt nail cutters are notorious for causing ingrown toenails. :`”,

    Have a great day! http://www.healthmedicinelab.com/earache-remedies/

  • Douglas

    What about olive oil for the skin? When an MD looked at my legs the last time I was hospitalized for infection, she noted that a few of her patients had lymphedema, and used olive oil for their skin. Your opinion?

    • Joachim Zuther

      While we would suggest lotions, such as Eucerin or Lymphoderm, olive oil may also be used to moisturize lymphedemateous skin

  • I am from South Africa I got heridt lymphedema(R leg)for the past 3yrs each time I got infection my R leg get swellen and very sore.What can I use to drain this fluid out or what to eat or not to eat

  • Sleepwalker

    Dr. Zuther,

    Thank you for continuing to educate us about Lymphedema.

    I’m confused. Your blog recommends pushing back cuticles but not cutting them. But you also provide a link to the Lymphedema People blog, and they offer contradictory advice: “Cut your nails with nail clippers and use hand cream regularly. Never push back or cut your cuticles.”

    I’m not a vain person, but my nails have really taken a beating since my diagnosis, because I’m terrified of doing anything that might invite infection. This has only increased my level of self-consciousness. I showed up at my LE doctor’s appointment a few years ago with a stunning pedicure, and my doctor really let me have it.

    My lower extremity LE is under control (thank God) and I don’t see the harm in a gentle pedicure. In fact, I think it might be helpful in keeping nail growth under control, preventing ingrown toenails, and exfoliating the excess dead skin that tends to accumulate on my feet and ankles. I await your reply.

    • Joachim Zuther

      Please understand that – as you mentioned correctly – the most important aspect is to avoid injuries. Cuticles may be pushed back, but should not be cut.

  • Karen

    Dear Lymphedema Guru,
    It’s summer where I live and very hot. I have Lymphedema in my right arm, I wear a class 2 sleeve all the time, except when I run; then I wear a class 3. I try to stay out of the heat as much as possible, but we own an older home and our air conditioner is not terribly efficient. For the past couple of days, I have taken off my sleeve at night to find a rash on my arm , which appears to be heat rash. It’s not cellulitis; I have no fever. Is this a typical for people with Lymphedema?

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