FIRST... A LITTLE BIT OF BIOLOGY!Our skin is the largest organ of the body. It protects our body, regulates body temperature, is involved in Vitamin D synthesis and it also enables us to touch and feel.

Skin actually consists of 2 layers:

• The outer, or top most layer (epidermis) which is made up of 5 different layers of cells. The layers are continually renewed and shed every 3 weeks from the skin surface.

• The inner layer (dermis) which consists of collagen fi bres, blood vessels, nerve endings, hair follicles, sebaceous glands and sweat glands. This layer also contains tiny blind ended lymph vessels (initial lymphatics). They are connected to deeper lymph vessels and which together help to control microcirculation and our immune response to infection. Beneath these, a layer of fat (adipose) tissue containing veins and arteries attaches skin to bone and muscle. Which protects us from physical shocks and pressures.

SO…. What does the skin DO?• Supports and shapes us.

• Protects and prevents infection.

• Excretes waste (sweat).

• Regulates body temperature (sweat and hair follicles).

• Helps us feel and touch.

• Helps us make vitamin D for bone development.

WHY is this especially important to know when I have lymphoedema?PROTECTIONOur skin is our body’s fi rst line of defence against bacteria, viruses and allergens. SEBUM, an oily substance secreted by sebaceous glands, forms a protective fi lm which keeps skin supple and prevents it from drying out. In healthy, undamaged skin, sebum helps to prevent bacteria, viruses, other organisms and irritants from getting into the body.

If you have been told that you have lymphoedema, you have probably also been told that looking after your skin is now of paramount importance. In fact SKIN CARE is considered one of the ‘foundation stones’ of managing your condition well.

But WHY is it so much more important to look after your skin when you have lymphoedema or are at risk of developing lymphoedema?

This advice leafl et explains all about your skin and why and how you should look after it when you are living with lymphoedema.

SKIN CARE AND LYMPHOEDEMA

Anatomy of the Skin

SUPPORT AND SHAPINGHealthy, hydrated skin helps to provide a firm resistance for our muscles to work against. Which in turn assists the veins and lymph channels to transport blood and lymph fluid around the body. Because of the collagen in skin, it can also stretch when needed e.g. pregnancy, injury or as in lymphoedema. But, just as a balloon when inflated becomes thinner, so does stretched skin. And when it is thinner, it is less able to protect and fulfil its other functions. It becomes dry, prone to cracking, splitting, blistering and occasionally may even leak a straw coloured fluid called lymph. This is why we need to apply moisturisers regularly.

TEMPERATURE REGULATION and EXCRETION Sweat from sweat glands in the skin, cools the body as it evaporates (perspiration). Sometimes in LYMPHOEDEMA the swollen area seems to sweat more and is often cooler. People with foot and lower leg swelling sometimes notice this. This may be because the accumulation of lymph affects the action of sweat glands locally. It is not fully understood, but if this occurs, we need to be even more vigilant with skin cleansing.

If you experience this, make sure you discuss it with your lymphoedema specialist.

TOUCH AND SENSATIONTouch and pain receptors in the skin help us to interpret our surroundings e.g. recognise hot/cold. They also help us to react to painful stimuli. Sometimes skin can become extra- sensitive e.g. after nerves have been damaged. People with lymphoedema sometimes experience this. It may be due to nerve damage through treatment/surgery or pressure on nerves from the accumulation of fluid in the tissues.

If you experience this, do discuss the symptoms with your lymphoedema specialist.

AIMS OF SKIN CARE• To maintain healthy condition.

• To minimise any risk of infection or damage (including avoiding sun burn).

• To identify any problems early on and treat them.

HOW DO I LOOK AFTER MY SKIN?Everyone’s skin is different and you might find that the skin on your lymphoedema area is different to elsewhere.

• It may be more prone to flaking and dryness.

• It may sweat more/ or less.

• It may feel cold/clammy / or warmer.

• It may develop small lumps like hard blisters, or cracks and skin folds especially.

• If your swelling is more severe.

Skin may feel more sensitive, especially in areas where nerves have been damaged by treatment/injury.Your skin will also be more sensitive to the sun and may burn more easily.

GET TO KNOW YOUR OWN SKIN. BECOME REALLY FAMILIAR WITH HOW IT LOOKS , FEELS AND REACTS. This way you’ll be able to spot problems at the first sign and get appropriate help and advice.

START A DAILY SKIN ROUTINE. START TODAY. AND DO IT EVERY DAY.

THE 3 C’s of SKIN CARE1 – CHECK… your skin daily, especially between fingers/toes and skin folds.

2 – CLEAN... the affected limb/area EVERY day, especially feet, hands and genital areas, if these are affected.

(IF you have facial oedema, don’t skip oral hygiene, it’s important to protect the skin inside the mouth as well.)

3 – CREAM… ALL of the affected area eg: hand, arm AND chest, shoulder, back on the same side.

TIP: Always apply moisturiser in the direction of body hair, in a gentle sweeping motion. This helps to prevent folliculitis (infected hair follicles).

WHAT PRODUCTS SHOULD I USE ?TIP: When trying out a product that is new to you, do a patch test ie: only use a small amount on a small area of skin. If there is no redenning, itching or irritation then it should be safe for your skin.

CLEANSING/WASHINGAlways try to avoid highly scented soaps/shower gels/bath products; they can cause skin sensitivity, and inflammation. Perfumed products often have an alcohol component which can dry out the skin and makes it more prone to infection.

SOAP SUBSTITUTES These are emulsions of oil-in-water eg: aqueous cream. (Take care when using oil based products, they can make the bath/shower slippery.) There are now many soap substitutes available on prescription and over the counter. ASK your lymphoedema specialist/GP about these.

TIP: ALWAYS check the ingredients list before you buy a new product.

CREAMS/MOISTURISERSThese are a combination of ointment and water. Stabilisers,emulsifiers and preservatives are added to keep themmixed and make them last. Some contain lanolin. If youhave any other skin condition/leg ulcers AVOID these lanolin based products because they can cause dermatitis. Ask for medical advice.

CREAMS Creams are best for lymphoedema because they are thicker and more moisturising. LOTIONS can be helpful if skin is otherwise healthy. They can be more cooling, but MAY cause more sensitivity.

OINTMENTS These tend to be thick and greasy, because they contain very little water. They prevent water loss from the skin and are used in patients who have very dry skin.Many products are available on prescription. ASK your lymphoedema specialist or GP about these.

TIP: Sometimes sensitivity occurs when a product has been used for a long time or when the ingredients are changed. If you develop a rash or itching after applying your moisturiser, wash the area and seek medical advice.

SKIN PROBLEMSFrom time to time we may develop minor skin problems and it is important that these are treated promptly.

FUNGAL INFECTIONSIf you have foot swelling you are more prone to fungal infections such as athlete’s foot (cracked, peeling skin between the toes)

• Use an antifungal cream and scrupulous footcare.

• Do not share towels or wash cloths.

• Dry thoroughly between toes.

• Wear clean hosiery EVERY day.

• Use high absorbency foot powder if your feet perspire excessively.

Be especially meticulous when using swimming pools, spas, always wear permitted foot wear in wet areas.

FUNGAL INFECTIONS can also occur in skin folds, such as axillae, groins and beneath the breasts. Antifungal creams are required. See your GP/lymphoedema specialist for appropriate advice and treatment.

CELLULITISThis is an acute infection and inflammation of the skin. It occurs when germs penetrate the skin.

What to look out for…

• Sudden onset.

• Redness and increased swelling in lymphoedematous area.

• Flu like symptoms: fever, shaking, headache, vomiting/nausea. Pallor or flushed face, feeling weak.

• Rash: may be blotchy, or small spots, or large red area.

• Skin surface feels hot to touch.

What to do…SEEK MEDICAL ADVICE IMMEDIATELY.

In people with compromised immune systems, such as lymphoedema, cellulitis can progress very rapidly. ANTIBIOTICS are needed as soon as possible.

In the interim:

• REMOVE YOUR GARMENT if it is too uncomfortable/becoming tight.

• START oral antibiotics if you have already been prescribed them as ‘in case’.

• TAKE paracetamol or Ibuprofen if you know these are safe for you. This will help to lower your fever and reduce inflammation.

• DRINK water to stay hydrated.

• REST.

• DO NOT do SLD/MLD until cellulitis is resolved.

• COMPLETE the course of antibiotics which your Doctor should prescribe. A 2 week course is recommended.

TIP: Keep a record of the symptoms and pattern of onset. This is useful for your health professional and will also help you recognise symptoms if it happens again. It will enable you to be prepared, minimise the effects and help you recover more quickly.

LYMPHORRHOEAThis is when LYMPH FLUID leaks out of the skin. It occurs when the tissues become so congested with non flowing lymph, that the skin is so stretched that it can no longer contain it.

When this occurs the skin is even more at risk from infection and further damage.

SEEK MEDICAL HELP IMMEDIATELY.

• CLEAN the area.

• MOISTURISE.

• APPLY ABSORBENT dressings.

• ELEVATE the limb.

You may need special compression bandaging to resolve the leakage and support the limb, before recommencing wearing your hosiery.

FOLLOW YOUR LYMPHOEDEMA SPECIALIST’S ADVICE.

An example of cellulitis.

SKIN CARE... THE 3C’S AND PAT!

LET your mantra be: `CHECK, CLEANSE, CREAM’. Then remember : P.A.T

P...PROTECT… use protective clothing when gardening, including gloves and sturdy footwear.

PREVENT... Sunburn by using high factor creams, wearing garment and covering affected area.

PREVENT... insect bites: use repellents and cover up.

A…AVOID… sharing wash cloths and towels.

AVOID… walking barefoot on pool-sides, beaches or grass.

AVOID… scented soaps, creams, shower/bath products and massage oils.

T...TREAT... any skin break, insect bite, fungal infection immediately.

TELL… your lymphoedema specialist or GP of any changes, rashes, sensitivities or damage that doesn’t resolve quickly with self treatment.

TAKE... CARE. DO YOUR SKIN CARE EVERYDAY!

REFERENCES.

INTERNATIONAL CONCENSUS for BEST PRACTICE FOR THE MANAGEMENT OF LYMPHOEDEMA. (2006)CONCENSUS DOCUMENT ON THE MANAGEMENT OF CELLULITIS IN LYMPHOEDEMA (2010)LYMPHOEDEMA , TWYCROSS, R , JENNS, K, TODD, J (2000)

FOR FURTHER ADVICE AND SUPPORT:

BRITISH LYMPHOLOGY SOCETY. www.thebls.comLYMPHOEDEMA SUPPORT NETWORK. www.lymphoedema.orgLIPOEDEMA UK. www.lipoedema.co.uk

Distributed by:

HUNTLEIGH HEALTHCARE, DIAGNOSTIC PRODUCTS DIV.Diagnostic Products Division35 Portmanmoor Rd.,Cardiff, CF24 5HN

Tel: +44 (0)29 20485885Email: sales@huntleigh-diagnostics.comWeb: www.lymphAssist.com

Content written and supplied by Sue Hansard B.A Nurs; R.N; FG.MLD. Lymphoedema Specialist Nurse. NMC 7812276EDistribution by Huntleigh Healthcare.

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