Lymphoedema and Skin Care

What Is The Lymphatic System?
As blood circulates around the body, fluid leaks out from tiny arterial capillaries known as arterioles. This fluid provides nutrients and oxygen to cells in the tissues. Most of the fluid returns to the blood vessels by tiny venous capillaries called venules, which pick up dead cells and other waste products from the cells in the tissues. The fluid that remains behind in the tissue spaces along with larger particles like proteins that are too big to re-enter the blood stream are picked up by the lymphatic system and are eventually returned to the bloodstream.

The lymphatic System is made up of Lymphatic vessels and lymph nodes. The smallest of the lymph vessels located just under the skin weave between the tissue cells and the arterial and venous capillaries in the tissue spaces and collect the excess fluid and large particles. These initial lymph vessels drain into larger vessels with one way valves which propel this fluid now called “lymph” towards the heart. Along the way, the lymph travels through lymph nodes where the fluid is filtered and special cells in the node destroy or contain organisms, bacteria and other debris so that they cannot travel to the bloodstream and spread to other parts of the body. There are about 600 nodes in the body with approximately 160 located in the neck. The size of a normal lymph node varies from 2mm – 3cm. On average the lymphatic vessels pump at a rate of 6 beats per minute which is far slower than the Vascular system and about 3 litres of lymph fluid is pumped around the body in a 24 hour period.
What is Lymphoedema?
Lymphoedema is a swelling caused by a buildup of protein rich fluid in the tissues and is a sign that the Lymphatic System is not working properly. This fluid behaves like a stagnant swamp and the cells cannot function as well and the tissues become clogged with waste. The most important of these cells are the Macrophages which are responsible for recognizing and ingesting foreign substances. In addition they assist other cells to activate the immune response and are therefore important in defending the body against bacteria.
There are two types of Lymphoedema, Primary and Secondary
Primary is caused by a poorly formed Lymphatic System. It can arise at Birth or Puberty and makes up about 10% of all Lymphoedemas. Secondary, is the result of trauma, surgery and removal of lymph nodes, with or without Radiation. Lymphoedema can arise immediately following surgery, or may not develop until months or years later. For some people, it may never develop. This dependant on how many Lymph Vessels and Nodes a person has before surgery and how many of these Vessels and Nodes had to be removed during Surgery.
Signs, Symptoms and Stages
Changes in; sensation, feelings of tightness, heaviness, swelling, aching and bursting pains.
Stage one
Acute phase – swelling lessens overnight. The skin is soft and when pushed in leaves a dent that fills again in a few seconds. Swelling is reduced by elevation and the limb is often normal or almost normal looking in the morning. The limb swells up again during the day. If this type of Lymphoedema occurs, it is often reversible with treatment and care.
Stage two
The skin thickens, hardens and becomes less elastic. There is less skin pitting. The limb becomes more sensitive to infection. By this time the condition is chronic, progressive and currently irreversible.
Stage three
Significant swelling and toughening of the skin is evident. Skin folds and deep crevices may occur. The limb may leak lymph fluid. Good early care can often prevent such problems.
Therapy assists with relieving the symptoms of Lymphoedema and involves Manual Lymphatic Drainage, Compression bandaging / compression garments, Exercise and Skin Care.
Skin Care
Skin care is one of the most important aspects in reducing your risk of getting Lymphoedema or making it worse. It is vital to maintain the integrity of the skin so that bacteria does not enter the body and lead to infection. When you get a cut or injury to the tissue, the area usually becomes red and warm. This is due to fluid and proteins leaking out of the blood vessels and into the tissues making it an ideal environment for bacteria to grow in. Due to the reduced number of Lymphatic Vessels and Nodes, the excess fluid remains in the tissues and swelling results.
Maintaining Skin Integrity
• Wash daily using a pH neutral soap or soap substitute and dry thoroughly
• Moisturise daily with skin creams containing vitamin E and Aloe Vera or Sorbelene to maintain its suppleness. Care needs to be taken with compression garments as creams can damage the elastic components of the garments therefore do not moisturise immediately prior to donning garments
• Apply antiseptic creams such as Betadine to cuts and scratches immediately and cover with a fabric dressing
• Care should be taken when cutting nails and cuticles should not be cut
• Inspect skin for signs of fungal infections and treat appropriately
• Electric razors should be used to remove hair
• Use insect repellants in mosquito infested areas
• Where possible do not allow blood to be drawn or injections on affected or susceptible limbs. Sometimes this may be unavoidable
• Do not get sunburned – always wear a sunscreen or protective clothing and maintain a high moisture level on the skin.
• Wear protective gloves in the garden
• Wear rubber gloves when washing up and protect your hands when doing things like cooking, fishing, sewing or cutting up things.
• Treat even minor burns with cold running water. Keep an antiseptic or antibiotic in the house
If your limb appears bright red, painful, hot or swells rapidly then this usually means that you have a bacterial infection called Cellulitis also known as Erysipelas. You may also experience other symptoms such as fever, chills, headache, nausea, vomiting and generally feeling unwell. It is important to contact your Doctor or Hospital as soon as possible so that the infection can be treated with antibiotics. Good skin care reduces the likelihood of Cellulitis and further damage to the Lymphatic System.
If you are concerned that you have Lymphoedema or you are at risk of developing Lymphoedema please feel free to contact me for a consultation.
Diane Lacey
Registered Nurse, Lymphoedema & Massage Therapist
Office 4
Professional House
12~18 Seddon Street
Pohutukawa Place Ltd
mobile: 021 142 9338
By appointment only.