Skin care in patients with lymphoedema Ian Pearson Consultant Dermatologist Christchurch hospital Royal Bournemouth and Christchurch Trust
Skin care in lymphoedema Why required? Practicalities hints and tips Presentations of associated skin disorders Answers any questions.
nbnbn Skin lymphatics
Lymphoedema Accumulation of tissue fluid in dermis Localised immune dysfunction Secondary skin changes Diagnosis.
Lymphoedema - diagnosis Clinical Elephantiasis Hyperkeratosis Lymphangiectasia Skin thickening Stemmer s sign Unable to pick up skin 2 nd toe
Skin barrier function Skin treatments
Lymphoedema and skin barrier Lymphatic destruction / loss of wbc trafficking Infection Lymphoedema Skin changes Infection prevention is vital
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
Lymphoedema and skin barrier: Emollients Wide range patient preference Dorset Formulary ladder of oiliness Thicker ointments vs drier skin
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
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
Lymphoedema and skin barrier: Emollients Moisturising both legs and feet BD how long does 500g last? 10 days 25 days 40 days
Lymphoedema and skin barrier: Emollients Urea containing Balneum, Hydromol intensive, Eucerin Half-strength Whitfield s ointment
Lymphoedema and skin barrier: Soap substitutes Any soap irritant / drying NB SLS Bath oils Short-lived effect Dangerous!! Shower emollients / washes Eg Dermol 500 - antiseptic
Lymphoedema and skin barrier: Practical washing tips Pat dry not rub Dry thoroughly Care with cracks / crevices eg between toes Good inspection opportunity
Lymphoedema skin complications. Fungal infection Tinea sp. Skin scrapings from feet + nails Entry site for bacteria Treatment Topical terbinafine
Fungal infection in lymphoedema Nail treatment oral therapy?
Lymphoedema skin complications 7 days in hospital Legs red / swollen / painful Stasis dermatitis / acute lipodermatosclerosis
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
Lipodermatosclerosis..acute Red leg(s), systemically well
Lipodermatosclerosis..chronic Red leg(s), systemically well
Lymphoedema skin complications Stasis dermatitis / acute lipodermatosclerosis Elevation Double layer tubigrip KMnO 4 soaks Fucibet cream od
Lymphoedema skin complications Eczema / Dermatitis? Cause Skin barrier dysfunction Lymphoedema Age Diuretics etc
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.
Adult: lower legs + feet 10 FTU
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
Eczema treatment.of barrier Emollients Soap substitutes Prevention
Autosensitisation of eczema
Contact eczema irritant / allergic
Contact irritant eczema Topical application / bandage / stocking Soaps, fragrances Friction / heat Treatment - avoid irritant - eczema
Contact allergic eczema Type IV allergic reaction Patch testing extended series Range of allergens NB Rubber series Referral to secondary care
Skin complications lymphoedema Lymphorrhoea Leaking tissue fluid Maceration Ulceration
Skin complications lymphoedema Lymphorrhoea Soaks to dry out Elevation Bandaging Topical corticosteroid Eg Betnovate C cream
Lymphorrhoea and ulceration Management as per venous ulceration
Skin complications lymphoedema Lymphangiectasia Responds to oedema reduction Recognition
..beware atypical Lymphangioma circumscriptum
Classical Kaposi sarcoma
Classical Kaposi s sarcoma
Skin care in lymphoedema Skin barrier maintenance vital Recognise associated skin changes Awareness of skin complications
Thank you!