Complications

Infections can be a complication associated with lymphoedema. They are dangerous to anyone, but especially for those with lymphoedema.

Types of Infections

Fungal infections
The two most common places for fungal infections are between skin folds and between the toes. A fungal infection between the toes is known as athlete’s foot or tinea pedis (see image below). Moisture can accumulate from sweat in skin folds. This can cause the skin to breakdown and lead to fungal growth. Fungal infections can also increase the risk of bacterial infections, which delay wound healing, and to the development of cellulitis. It is very important to thoroughly clean and dry skin folds and the spaces between your toes. Please click here for more information regarding how to reduce the risk of infection.


Tinea pedis
Erysipelas (bacterial infections)
Erysipelas is a superficial infection of the upper layer of your skin. With erysipelas, the infected area is generally raised above the level of the surrounding skin. With this type of infection, you will notice redness, warmth and a swelling that will come on quite quickly and blistering may occur. You may feel generally unwell with a fever and chills.

Cellulitis
Cellulitis is an infection involving the deeper layers of your skin. Similar to erysipelas, cellulitis presents with redness warmth and a swelling. You may feel unwell at first and symptoms may include a fever, chill, headache, nausea, aches and pains and the infected area may feel painful or tender. A mild infection may respond to oral antibiotics. However, a severe infection may require intra-venous antibiotics and hospitalisation. Treatment for lymphoedema should be put on hold temporarily to treat the infection (e.g. removal of compression garments). Cellulitis can come on quite suddenly and it is important to contact your GP or healthcare professional immediately so that you can commence an antibiotic treatment as soon as possible. 
 
Lymphangitis / lymphadenitis
Lymphangitis is an inflammation of the lymph vessels and lymphadenitis is the inflammation of the lymph nodes. These infections generally occur when bacteria enters the body, through an open wound or cut, and travels into your lymphatic system. Red streaks form on the skin and these conditions must be treated promptly with antibiotics.

Tinea pedis

Cellulitis

Other conditions that could be confused with an infection

Contact Dermatitis
Generally itchy, red, inflamed skin caused when your skin develops an allergic reaction after being exposed to a foreign substance. Contact dermatitis can sometimes occur under compression.

Acute Gout
An intensely painful arthritic condition that usually starts by affecting a single joint, most frequently the big toe, ankle or knee. An acute attack of gout can cause swelling, redness and severe pain and is easily confused with an infection.

Vasculitis
An inflammation of the blood vessels.

Insect Bite
Insect bites can lead to inflammatory changes with or without an infection. Treat with antiseptic solution/wipe or cream and cover with a plaster to keep clean.

Red Legs (or low grade inflammatory response)
‘Red legs’ is a low grade inflammatory response that is often confused with cellulitis. It is usually characterised by redness in both legs (bilateral) which is often red and warm with tenderness and a swelling. One way to distinguish red legs from an infection is the unusual symmetrical redness and the fact that antibiotics do not help. If you have been on antibiotics for a long time with no improvement, it is possible that you may have red legs and not cellulitis.

Folliculitis
Folliculitis is an inflammation of the hair follicle (a hair follicle is the area where the hair exits the skin). It is characterised by small red dots around the base of the hair follicle. It is commonly caused by irritation but can also be caused by bacteria or even fungal infections. Good skin care and avoidance of friction can reduce the risk of folliculitis.

What to do if you think you may have an infection

  1. Contact your GP or healthcare professional immediately as you may require an antibiotic treatment, especially if you have other symptoms such as nausea, vomiting and flu-like symptoms.
  2. Draw a line around the red area and note the date and time. That way, you can easily track if it is spreading and if so, how fast.
  3. Monitor the affected area closely. Make sure you check it several times a day until the infection is improving and under control.
  4. Temporarily suspend any treatment for your lymphoedema (e.g. compression or manual/simple lymphatic drainage) and ask you healthcare professional to advise when you can recommence your treatment plan. Treatments such as simple (or self) lymphatic drainage may spread the infection and cause the swelling to worsen, which makes treatment even more difficult. 
  5. If you have an infection, you may be prescribed antibiotics or even hospitalised for intra-venous antibiotics. It is important that you fully complete the prescribed antibiotic course. If you are prone to infections, or are planning to travel, it may be a good idea to talk to your healthcare professional about obtaining a prescription for oral antibiotics.
  6. Tell your healthcare professional if your swelling increases as you may require some intensive treatment to reduce the swelling after your infection has cleared.

How to reduce your risk of infection

  • Keep the affected limb very clean
  • Good skin care is very important
  • Wash the skin thoroughly and frequently and dry carefully
  • Keep your skin soft, supple and hydrated, to avoid drying and cracking, by applying creams at night that are recommended by your healthcare professional
  • Dry, cracked skin can become an entry point for bacteria and the risk of infection
  • Keep skin folds and the spaces between the toes clean and dry
  • Always keep your compression garments and bandages clean

Try to avoid injuries to the skin that can lead to infection, such as

  • Scratches or bites from pets or other animals
  • Bites or stings from insects; use an insect repellent
  • Unnecessary skin punctures on your swollen limb/s (injections, blood samples, blood pressure readings, acupuncture, tattoos or piercings)
  • Scratching your skin or nail biting, which can be a potential route for infection
  • Use of razor blades; instead use depilatory (hair removal) creams
  • Make sure to clean all cuts, scrapes and insect bites and keep covered up
  • It is a good idea to keep a small first aid kit with you when you travelling or are outdoors
insect bite

Insect bite