Lymphedema Related Infections

INTRODUCTION

The most frequent medical emergency associated with lymphedema is caused by a bacterial infection in the affected limb. These infections  require prompt medical attention and treatment with a full course of antibiotics!

The difference among such infections occurring among the population with lymphedma, as opposed to those without lymphdema, is dramatic.

• In Stage 1 lymphedema the incidence of infection is 1 per 100 patients, or 1,000 times greater than the normal population.
• In Stage 2 lymphedema the incidence is 27 per 100 patients, or 27 greater than Stage 1.
• In Stage 3 lymphedema the incidence is 72 per 100 patients, or about 3 times greater than Stage 2.

Erysipelas blisters. © Lymph Notes

SIGNS AND SYMPTOMS OF A DEVELOPING INFECTION

Signs and symptoms of a developing bacterial infection include:

• Redness and warmth of the affected tissues.
• Streaky red lines on the skin.
• Increasing swelling and pain in the affected area.
• Chills and fever.
• Malaise (not feeling well) and having flu-like symptoms.
• Lymph nodes swelling as the body fights to control the infection.

WHAT TO DO

Some medications increase    lymphedema swelling.

DO NOT WAIT! At the first sign of any type of developing infection seek prompt treatment with antibiotics.

• Even if the limb is still in the “at risk,” stage, these signs are clues that lymphedema is developing. Although you may not yet have been diagnosed as having lymphedema you need immediate medical care.
• If your physician is not readily available, go to the nearest urgent care center or emergency room (ER).
• When you check-in, mention that you have lymphedema, or are at risk of developing it. (Be prepared to explain what lymphedema is!)
• If treatment is delayed and the infection becomes more serious, hospitalization may be required to facilitate the intravenous administration of the antibiotics.

FIRST-AID

Minor cuts, bumps, and scratches are usually a part of everyday life for most people; however for those with, or at risk of developing, lymphedema any break in the skin requires prompt and appropriate first aid treatment.

Depending on that has happened, good first aid at home is sufficient. But, when a lymphedema affected tissues are involved, it may be necessary that you seek a prompt medical care from your healthcare provider, an urgent care center, a local ER, or by calling 911. When making such contact, be certain to mention that you have lymphedema.

After the injury has been treated it is important to continue to check that area frequently for indication of infection throughout the healing stage. At the first sign or symptom of infection it is important to seek medical treatment immediately.

MINOR CUTS, SCRATCHES, and PUNCTURE WOUNDS

In tissues affected with lymphedema a break in the skin as minor as a pinprick or a tiny paper cut, can easily become infected. It is essential that any break in the skin be treated properly.

• Bleeding helps to clean out wounds, and most small cuts or scrapes will stop bleeding in a short time. If the bleeding does not stop in a timely manner, seek medical care.
• DO NOT apply hydrogen peroxide or an iodine solution to an open wound. These substances are toxic to the cells of a wound. Instead carefully clean the wound with mild antibacterial soap and clean water or with the solution recommended by your doctor.

Get advice from your physician before applying over-the-counter topical antibiotic cream such as Neosporin® to the wound. 

• Some physicians recommend the use of these creams.Other physicians DO NOT recommend using antibiotic cream for this purpose. 
• Some patients develop a blister-like allergic reaction to these products. 

Place a sterile bandage over the wound. A band-aid that is large enough to surround the wound without sticking to it usually works well. 

For very sensitive skin, seek advice from your physician.

BRUISES

• If the bruise is on, or near, lymphedema-affected tissues examine the injured area carefully to determine if there is any break in the skin. If the skin is broken, treat this injury as a cut or scratch.
• If the skin is not broken, the bruise must still be treated. The standard bruise treatment is to alternate ice and heat over the injury for the next 48 hours; however, since heat is not recommended on lymphedema-affected tissues, this step must be modified.
• The swelling should be reduced and the discoloration is minimized by placing a cool pack on the injury for no longer than 20 minutes at a time.  Then alternate cool packs with mild to moderate warmth.
• Do not place an ice pack directly over the injured area. Instead use either a cold, clean wet cloth or a reusable "cold pack" that is wrapped in several layers of cleaning toweling.
• Perform self-massage on the tissues closer to the trunk. This will help minimize swelling, bruising, and discomfort.

ITCHY RASHES

• Do not scratch is the first rule of dealing with an itchy rash, such as poison ivy.
• Over-the-counter anti-itch ointments, such as Cortaid®, may help relieve the itching. If the itching is severe, seek medical help.
• If blisters are present, do not break them. Instead gently clean the area and apply an antibiotic cream.
• If the blisters begin to break seek medical help. Any break in the skin puts you at risk for developing an infection.
• Watch for trouble! The irritants that are producing the rash may cause increased swelling in the affected area and there is always the possibility of an infection.

INSECT BITES AND STINGS

When an insect bites, it injects a toxin into the skin that causes the resulting itching. The reaction in lymphedema-affected tissues to insect bites can be potentially be severe. In response to the bite, there may be a temporary increase in the swelling of the affected limb. Also, it may take lymphedema-affected tissues longer than normal tissues to clear this substance from the body.

• If you have multiple bites on an affected limb, seek medical advice immediately!
• Don’t scratch! A cool wet cloth or cold pack will ease the itching and swelling. If the itching is severe, seek medical help.
• As long as no infection present it should be safe to perform self-massage to help the body clear toxins from this area. When doing this, massage the area above the sting, i.e. closer to the trunk.
• An insect bite is a break in the skin and it must be treated as such. See instructions for treating Minor Cuts, Scratches, and Puncture Wounds.

ANIMAL BITES

Bites by dogs, cats, or other animals can cause serious puncture wounds and infections. These should be evaluated immediately by a physician for appropriate care including determining if the animal had rabies.

BURNS

This is an important rule for treating burns, "Do NOT place butter, oil, ice, or ice water on burns."

If the burn is on lymphedema-affected tissues, special precautions are required and hen you have any questions as to the seriousness of the burn, contact your physician promptly.

First Degree Burns which are are also known as superficial burns.

• A first degree burn has no blisters and there are no breaks in the skin. These burns are treated by cooling the affected area with a cool, wet cloth for 20 minutes and then removing it for 20 minutes. Repeat this until the area is pain-free. Then apply a low pH moisturizer, or an antibiotic cream, over the burn to prevent the damaged tissues from drying out. Provide additional protection over the affected area by covering it lightly with a dry gauze bandage.
• Second degree burns, also known as partial thickness burns, have blisters and damage to the outer layer of skin. This is a break in the skin and a second degree burn on lymphedema affected tissue should promptly be evaluated and treated by a physician.
• Third degrees burns, also known as full-thickness burns, can be a life threatening emergency that requires immediate medical treatment. The severity of these burns destroys all layers of the skin and the underlying fat, muscles, bones, and nerves.
• Second and third degree burns should be treated immediately as a medical emergency.

REFERENCES

• Living Well with Lymphedema by A. Ehrlich, A. Harrewijn PT, CLT-LANA and E. McMahon PhD. Lymph  Notes, 2005.
• American Red Cross Emergency Response. Staywell, 2001 pages 249-256.
•  Lymphedema Caregiver’s Guide by M.K. Kearse, PT, CLT-LANA, E. McMahon PhD, and A. Ehrlich MA. Lymph Notes 2009.
• Lymphedema Management: The comprehensive Guide for Practitioners by J.E. Zuther 2-E. Thieme, 2009.

© LymphNotes 2014. This information does not replace the advice of a qualified health care professional.

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Category: Lymphedema Emergencies and Complications Updated: 2014-06-18