Skin care in patients with lymphoedema. Ian Pearson Consultant Dermatologist Christchurch hospital Royal Bournemouth and Christchurch Trust
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1 Skin care in patients with lymphoedema Ian Pearson Consultant Dermatologist Christchurch hospital Royal Bournemouth and Christchurch Trust
2 Skin care in lymphoedema Why required? Practicalities hints and tips Presentations of associated skin disorders Answers any questions.
3 nbnbn Skin lymphatics
4 Lymphoedema Accumulation of tissue fluid in dermis Localised immune dysfunction Secondary skin changes Diagnosis.
5 Lymphoedema - diagnosis Clinical Elephantiasis Hyperkeratosis Lymphangiectasia Skin thickening Stemmer s sign Unable to pick up skin 2 nd toe
6 Skin barrier function Skin treatments
7 Lymphoedema and skin barrier Lymphatic destruction / loss of wbc trafficking Infection Lymphoedema Skin changes Infection prevention is vital
8 Skin care in lymphoedema - evidence Community based camps in Kerala, India Endemic Lymphatic filiariasis Taught skin washing + drying, topical treatments Reduced infective episodes Improved quality of life
9 Lymphoedema and skin barrier: Emollients Wide range patient preference Dorset Formulary ladder of oiliness Thicker ointments vs drier skin
10 Emollients GREASINESS 50:50 LP in WSP Epaderm / Hydromol ointment Hydromol cream Diprobase, Doublebase, Cetraben Aveeno cream, Dermol cream Dermol 500 lotion Oil-based may be better barrier eg 50:50 Aqueous cream perturbs skin barrier
11 Lymphoedema and skin barrier: Emollients Apply regularly (BD minimum) Direction of hair growth Adequate volumes 30 mins plus after topical steroid / active agents Before steroid if sensitive
12 Lymphoedema and skin barrier: Emollients Moisturising both legs and feet BD how long does 500g last? 10 days 25 days 40 days
13 Lymphoedema and skin barrier: Emollients Urea containing Balneum, Hydromol intensive, Eucerin Half-strength Whitfield s ointment
14 Lymphoedema and skin barrier: Soap substitutes Any soap irritant / drying NB SLS Bath oils Short-lived effect Dangerous!! Shower emollients / washes Eg Dermol antiseptic
15 Lymphoedema and skin barrier: Practical washing tips Pat dry not rub Dry thoroughly Care with cracks / crevices eg between toes Good inspection opportunity
16 Lymphoedema skin complications. Fungal infection Tinea sp. Skin scrapings from feet + nails Entry site for bacteria Treatment Topical terbinafine
17 Fungal infection in lymphoedema Nail treatment oral therapy?
18 Lymphoedema skin complications 7 days in hospital Legs red / swollen / painful Stasis dermatitis / acute lipodermatosclerosis
19 Lipodermatosclerosis -pathophysiology High venous pressure (causes++) Transmits to microcirculation dermis Dermal capillary leak macromolecules inc fibrinogen -> fibrin Trapped wbc s inflammatory mediators eg TGFbeta / ICAM-1 / V-CAM-1
20 Lipodermatosclerosis..acute Red leg(s), systemically well
21 Lipodermatosclerosis..chronic Red leg(s), systemically well
22 Lymphoedema skin complications Stasis dermatitis / acute lipodermatosclerosis Elevation Double layer tubigrip KMnO 4 soaks Fucibet cream od
23 Lymphoedema skin complications Eczema / Dermatitis? Cause Skin barrier dysfunction Lymphoedema Age Diuretics etc
24 Eczema treatment.of inflammation Topical corticosteroids NB Ointments 1% hydrocortisone x1 Class I Eumovate / Betnovate RD x25 Class II Betnovate/Elocon x150 Class III Dermovate x600 Class IV Quantities.
25 Adult: lower legs + feet 10 FTU
26 Lymphoedema and skin treatment: Topical corticosteroids Treating both legs and feet BD how long does 30g of fucibet last? 18 days 12 days 6 days
27 Eczema treatment.of barrier Emollients Soap substitutes Prevention
28 Autosensitisation of eczema
29 Contact eczema irritant / allergic
30 Contact irritant eczema Topical application / bandage / stocking Soaps, fragrances Friction / heat Treatment - avoid irritant - eczema
31 Contact allergic eczema Type IV allergic reaction Patch testing extended series Range of allergens NB Rubber series Referral to secondary care
32 Skin complications lymphoedema Lymphorrhoea Leaking tissue fluid Maceration Ulceration
33 Skin complications lymphoedema Lymphorrhoea Soaks to dry out Elevation Bandaging Topical corticosteroid Eg Betnovate C cream
34 Lymphorrhoea and ulceration Management as per venous ulceration
35 Skin complications lymphoedema Lymphangiectasia Responds to oedema reduction Recognition
36 ..beware atypical Lymphangioma circumscriptum
37 Classical Kaposi sarcoma
38 Classical Kaposi s sarcoma
39 Skin care in lymphoedema Skin barrier maintenance vital Recognise associated skin changes Awareness of skin complications
40 Thank you!
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DRUG THERAPY TOPICS A Qualitative and Quantitative Assessment of the Application and Use of Topical Acne Medication by Patients James Q. Del Rosso, DO Management of acne requires proper application of
Dermabrasion. Dermabrasion can decrease the appearance of wrinkles. It can also improve the look of scars, such as those caused by surgery or acne.
Dermabrasion Introduction Dermabrasion is a procedure that resurfaces a person s skin. A health care provider uses a device known as a dermabrader to quickly sand away the outer layers of skin. After dermabrasion,