June 8, 2018

Skin and Wound Care

Wounds are the enemies of those suffering with adipose tissue and lymphatic diseases, especially those with  Lymphedema and Lipo-Lymphedema!  Some wounds causing minor symptoms like redness or itchy and other wounds can outright kill you.  When you have one of these diseases you need to be constantly vigilant about items around you that can cause you harm, such as:

  • items that can cut, scrape, puncture or bruise – furniture, open drawers, items with sharp edges, plants
  • animals in your care – claw scratches or teeth bites
  • items that can burn you – hot stove, oils, fireplaces, fire pits, heaters
  • animals that sting – mosquitoes, bees, reptiles
  • hidden items that make you sick – germs, strong fumes, others with unclean body parts or contagious conditions

These kinds of situations can cause injury to your already damaged limb(s), arm(s), neck, face or abdomen areas. One minute of injury can cause hours, days, weeks or months of great discomfort, relentless itching, burning skin, weeping, and agonizing pain that may require professional assistance from emergency room staff, your doctor or a wound care clinic.  It is important to reduce your exposure to those things that cause you harm and to know what to do once you have sustained an injury.  Here is a common list of wounds and what you can do to mitigate them.

Bruising

Most people will dismiss a small patch of black and blue as nothing to worry about.  However, for those with impaired lymphatics or fat disorders need to understand that bruising is something to monitor for excessive bleeding under the skin and if the skin breaks.

Bruising on legBruises that result in skin breaks need to evaluated if a doctor’s attention is required.  Skin breaks that bleed help clean out the wound. Do not use iodine or hydrogen peroxide, which are toxic to cells of wound, to clean out the wound. Use an antibacterial soap and water to gently clean the wound.  You can use neosporin if you can tolerate it (some are allergic) or just dress the wound with suitable size bandage or gauze pad with (allergen free) medical tape. Monitor for proper healing.

Bruises without broken skin that are large in size should be treated with ice for 20 minutes to help reduce the swelling around the affected area.  You can also alternate ice and heat on the bruised area for 24 hours.  Bruising will cause additional swelling in an area that is already swollen with excess lymph fluid.  To facilitate reduction in swelling you can perform a self massage on the area around the bruise to manually move fluid.  Gently move your hand along the skin towards the direction of the heart.  Then massage the areas of your trunk to keep fluid moving towards the heart.  Major node clusters are located in your groin, your neck and your armpits.

Personal:  I just recently healed a large bruise about eight inches in diameter in the skin fold above my right knee that happened when overstretching to the knee burst a blood vessel in my Lipedema fat.  It was painful and swelled up large enough to put pressure on the knee area.  I used ice and manual massage to move the excess fluid out out the area.  It took about five weeks to completely heal the area.

Minor Cuts, Punctures and Scrapes

Cut in arm with Lipo-Lymphedema
Cut in arm with Lipo-Lymphedema

Anything that breaks the skin in an area with Lymphedema can be complicated.  Some cuts or puncture may only weep (slow leak) lymph fluid, also known as lymphorrhea, , some may bleed and some may do both.  Skin breaks that bleed help clean out the wound. Do not use iodine or hydrogen peroxide to clean out the wound. Use an antibacterial soap and water to gently clean the wound.  You can use neosporin if you can tolerate it (some are allergic) or just dress the wound with suitable size bandage or gauze pad with (allergen free) medical tape. Elevate the affected area to help get excess fluid moving away from the wound.

Don’t panic if a clean weeping cut or puncture doesn’t heal for a day or two.  Bleeding should stop fairly quickly. If after cleaning the area, elevation and bandaging still doesn’t work you will want to contact your doctor or emergency room for assistance.  You need to be vigilant with ANY open wound that you do not contract a bacterial infection!

Personal: most of puncture happen from my dog or cat’s nails.  Most of them will weep for a couple hours to a day before closing the hole.  I make sure to clean all scrapes and punctures to avoid infection.  I have had one major infection that I do not wish to repeat!

Rashes

Bruise and rash from IV needle
Bruise and allergy rash from tape on IV needle

Rashes can be caused by outside factors, such as poison ivy, sumac, oak or other plant, by something applied topical or ingested.  The rash may be a small patch, encase a good part of a limb or affect many body parts.  It can also present with fluid-filled blisters or large hives.  DO NOT ITCH the affected area!  I know that is hard to do, but you need to remember opening any portal into your skin will invite unwanted bacteria infections.

If you can tolerate topical cortisone creams you can use one on your rash area to help quell itching and quiet the affected area.  If you have never used a cortisone cream or the over the counter cream isn’t working consult your doctor for something you can tolerate.  Keep the area clean and call your doctor if anything changes in the look and feel of the rash.

Personal:  I have also used good old Calamine lotion and cold wet washcloths to help with the itching.  Boy, was it hard not to itch the area.  I also had a whole body hive situation due to an allergic reaction to ibuprofen.  I used topical cream, cold washcloths, Calamine lotion and Benadryl (at the advice of my doctor) to help combat the hives, which took two weeks to clear up.

Burns

Burns on lymphedema skin require special care and attention which includes consulting your doctor or emergency room. Do NOT place butter, oil, ice, or ice water on burns!

  • 1st, 2nd and 3rd degree burns
    1st, 2nd and 3rd degree burns

    1st degree burns are known as superficial burns.  There are no breaks in the skin or blisters.  You can treat these burns by holding the affected area under cool running water or using a cold wet washcloth for 20 minutes.  After that you can an antibiotic cream or low pH moisturizer to treat the area. You can also use a light bandage to help protect the burn area.

  • 2nd degree burns have blisters and damage to the outer layer of skin.  This constitutes a break in the lymphedema skin and should be treated immediately by your doctor or emergency room department.
  • 3rd degree burns are the most severe and require immediate attention by emergency room physicians.  These burns destroy all layers of the skin, the underlying fat, muscles, bones and nerves.  These burns can be life threatening especially those with compromised systems, such as those with Lymphedema.

Skin Tears and Fungal Infections

Skin fold tear in crease of leg
Skin fold tear in crease of leg

In advanced stages of Lymphedema or Lipo-Lymphedema you will have folds of skin that may overhang the knees, ankles, upper thighs and belly (called a panis).  Inside these folds are skin creases that are thin and hidden from circulating air.  This creates a perfect stage for fungal or yeast infections to develop and thrive.  If not cleaned regularly the hot moist climate will cause the skin to weaken and either an infection or skin tear may occur.  This makes moving painful as the affected areas rub together.

For fungal infections I recommend cleaning the area very well and applying an anti-fungal cream that blocks their growth and keeps the are dry.  You can use it under your belly/panis, under your breasts or even on your backside (if you have trouble keeping yourself sparkling clean).

For skin tears you need to clean the area well and apply a topical antibiotic (sometimes over the counter Neosporin will work or you may need something stronger in prescription form) to help seal and heal the tear.  Keep reapplying as necessary until the tear has healed.

Personal:  I had a skin tear in my upper left thigh area that may sleeping very painful as I can only sleep on my left side.  Neosporin didn’t works this time but the prescription antibiotic topical cream did.  It took four to seven days to heal and I had to sleep with a pillow between my legs to avoid it rubbing with the other leg.  Walking was also somewhat painful.

Bacterial Infections

Bacterial infections in the affected lymphedema limb are the most frequent and serious medical emergencies of all wounds.  These infections require prompt and even preventive attention with antibiotics when they emerge!

There are several bacteria responsible for creating serious infections in your system.  They are Streptococcus (strep throat, scarlet fever) and Staphylococcus (staph) that can cause cellulitis and impetigo, methicillin-resistant Staph aureus, Hemophilus influenzae, Pneumococcus, and Clostridium species can also cause cellulitis.  Lymphangitis, which is an infection of the lymph vessels can develop, usually caused by Streptococcus bacteria. If left untreated, it can spread to the skin, causing cellulitis, or into the bloodstream, causing septicemia, or sepsis.

The difference among such infections occurring among the population with lymphedma, as opposed to those without lymphdema, is dramatic. (1)

  • 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.

The most common bacteria infection that affects those with Lymphedema is cellulitis.  Cellulitis affects all layers of the skin and can present fairly quickly. Symptoms of cellulitis, which mainly occurs in the legs of those with lymphedema are:

  • Redness and warmth of the affected tissues (look and feels like a bad sunburn)
  • Streaky red lines on the skin 
  • Increasing swelling and pain in the affected area (think sunburn feeling)
  • Chills and fever (as your body tries to fight this serious infection)
  • Malaise and having flu-like symptoms
  • Swollen lymph nodes (sign your body is fighting to contain the infection)
Cellulitis Ulcer
Cellulitis Ulcer 6-7″ on back of leg

If you see or experience any of these symptoms, especially the tell-tale sunburn like symptoms you need to see a medical professional as soon as possible for antibiotics!  Ideally, the protocol of those suffering with Lymphedema is to have a bottle of antibiotics on hand at home so they can be taken immediately without delay!  Most people will respond well to oral antibiotics while others may need stronger antibiotics usually administered via and IV line. Timing is very important when getting treatment.

The following are some examples of antibiotics that have been used to treat cellulitis (2):

In all cases, physicians choose a treatment based upon many factors, including the location and extent of the infection, the type of bacteria causing the infection, your medication allergies, and your overall health status.  Of course, be sure to tell or remind the treating medical professional of any allergies you have to proposed antibiotics!  You don’t want to make a bad situation worse.

If you cannot start treatment right away further complications will develop, such open wounds and ulcers, which will require advanced treatment from your wound care clinic.  This will involve more pain, temporary limited loss of limb functionality, additional topical medications, bandaging and maintaining a constant vigil to ensure the wound is healing and not succumbing to further infection.

Personal: I had a strep throat in 2008 that was treated with Cephalexin, which turned out I was allergic too and ended up in the hospital fighting a medicinal allergy and untreated strep.  The strep toxin settled in my legs creating a bout of cellulitis.  It all happened so fast that I had a pic line installed in my left arm and chose to treat at home, giving myself multiple antibiotic injections each day for several weeks.  A large deep ulcer developed on the back of my lower right leg that almost had to be cut out because we couldn’t find a treatment to stop the bacteria growth.  Our last attempt worked and it took over six months to heal the ulcer.  I’m sure many of you know what I am talking about!

Takeaways on Wound Care

People with Lymphedema, especially those with advanced stages, are at high risk of wounds occurring in affected skin areas.  You need to be prepared to treat these injuries or infections or have an emergency plan for treatment at your doctor’s office or emergency room.  Tell your treating medical professional that you have Lymphedema and be prepared to explain what that is.

Skin and Wound CareAssemble and keep a first aid kit at home suitable to treat your condition.  In addition to the standard kit you may want to include non-allergic medical tape, assorted gauze size bandages, neosporin (or other topical cortisone or antibiotic cream), and your emergency antibiotic prescription for bacterial infections.

Personal hygiene is essential to preventing fungal infections, skin tears and wounds in fold creases and reducing areas where bacteria might enter your body.  Cut your toe and finger nails short to avoid accidental scrapes, cuts and itching of your skin. Keep your skin hydrated and use special moisturizers to repair dry skin and lock in hydration, such as Eucerin or CeraVe.

Take good care of your beautiful self and body.  You know what looks and feels normal.  Always check in with your medical professional(s) whenever something looks or feels wrong with your body!

 

To your improved health!

 

References:

 

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