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Lymph-what-oedema

Primary & Secondary Lymphoedema Online & in the Community

Cellulitis

Welcome to our L-W-O page on Cellulitis.  This page and its photographs are supplied by L-W-O members. The drop down menu at the top of the page information on The Lymphatic System.

Protect

For those of us that have lymphoedema we need to protect ourselves from inflammation and whilst this will seem like common sense to most of us, I have spoken to people who were never told about the risks.  The tips and advice on this page are designed to help you the reader cut your risk of cellulitis.

What is Cellulitis

Cellulitis is a sudden, non-contagious infection of the skin, characterised by redness, swelling and heat, accompanied by pain and tenderness. 

People with lymphoedema are particularly susceptible to cellulitis because the lymphatic system is damaged and frequently does not function adequately to fight infection.

What causes cellulitis

The infection may enter via a break in the skin, such as a scratch or insect bite or through a re-existing wound or ulcer, or through an area of skin inflammation, e.g. athletes foot, eczema or dermatitis. 

However, it may not be possible to identify the cause and an attack may arise without warning.

How can I recognise Cellulitis?

The patient often feels unwell, as if 'flu' is starting. 

Symptoms can include;

  • fever
  • shivers
  • muscular aches and pains
  • headache, nausea
  • vomiting  
  • acute spreading inflammation of the skin

The swollen area usually develops a rash or becomes red, hot and tender to touch. 

Swelling may dramatically increase and pain may occur in the swollen area, or the arm pit, with lymphoedema of the arm, or groin with lymphoedema of the leg.

The above photograph was taken by L-W-O member Lyn Harris in 2012

Temperature

I cannot emphasise enough the importance of taking your temperature.  From the start your temperature can rise very quickly so it is important to keep a thermometer at home.

L-W-O recommends you keep a first-aid kit at home see ours;

www.lymph-what-oedema.com/holiday-care/first-aid-kit

Preventing Cellulitis

If you have had cellulitis ,then it is highly likely that you will get it again.  Unfortunately, it is not always possible to prevent it from coming back.  Therefore, you need to take your own preventative measures.

  • wash hands regularly
  • moisturize your skin daily to prevent skin drying out or cracking
  • ​prevent cuts and grazes by wearing gloves when doing DIY or gardening
  • keep arms and legs covered when doing DIY or gardening
  • protect your arms and legs from pets biting or scratching
  • ​cuts, bites, grazes keep clean, wash gently under running water, gently pat dry and cover with plaster or dressing
  • carry alcohol wipes in your bag or car for when you are not at home

​​Please remember athlete's foot, eczema and leg ulcers can increase your risk of cellulitis so if you have any of these conditions please talk to your GP.  Unfortunately, if you carry extra weight you can increase your risk of cellulitis.

 

​Speak to your GP if your cellulitis comes back or is not healing as your GP will have the option to refer you to a dermatologist, or skin infection consultant.  You can then discuss whether there is an option to take antibiotics on a long-term basis to protect from further infections.

​For further skin-care information click on this link;

www.lymph-what-oedema.com/skin-care

 

Or for Healthy Living options click on this link;

www.lymph-what-oedema.com/healthy-living

Infection Journey

This is photograph from L-W-O member Clare, reproduced with her permission and is the start of her cellulitis infection.  You can see the faint lines of the marker pen that Clare used to map the journey of her infection.  See also Clare's second photograph.

 

What should I do if I develop Cellulitis

Contact your GP immediately as you will need antibiotic treatment.  Treatment of cellulitis in lymphoedema is very important, not only because the sufferer may become very ill, but because lymph drainage routes risk being damaged further.

Original article was written by Denise Hardy, LSN Nurse Advisor to check it out yourself, follow the link below.

http://www.thebls.com/the-bls/professional-and-patients/cellulitis-in-lymphoedema/

L-W-O recommends that in case of infection mark the infected area with a pen/marker so that if it spreads quickly your GP or the hospital can see how far it has spread.  See both Clare's photographs.

Antibiotics - Home Management

Oral amoxicillin 500mg 8-hourly is the treatment of choice.  If there is any evidence of Staph aureus infection e.g. folliculitis, pus formation or crusted dermatitis, then flucloaxcillin 500 mg 6-hourly should be prescribed in addition or as an alternative.

Microbiologists suggest that the use of a single agent flucloaxcillin for all cellulitis covers both Strep and Staph, infections.  This is therefore, an acceptable alternative.

Patients who are allergic to penicillin should be prescribed erythromycin 500mg 6-hourly or clarithromycin 500mg 12-hourly.

If there is a poor response (unresolving inflammation or development of systemic symptoms) or oral amoxicillin after 48 hours, then clindamycin 300mg 6-hourly should be substituted as second line oral treatment.

Antibiotics should be continued until all signs of acute inflammation have resolved; this may mean taking antibiotics for 1 - 2 months and the course of antibiotics should not be less that 14 days from the time a definite clinical response is observed.

Skin changes e.g. discolouration/staining may persist for months or longer following severe cellulitis and do not necessarily require ongoing antibiotics.

Tips:

  • bed rest
  • elevation of affected part
  • avoid compression garments during acute attack
  • use compression when it is comfortable enough to tolerate them

Appropriate analgesia e.g. paracetamol, as necessary.  It is probably advisable to avoid NSAIDS e.g. ibuprofen during an acute attack.  On occasions these medications may be associated with rare complications such as necrotizing fasciitis.

When inflammation is sufficiently reduced, wearing of compression garments and normal levels of exercise may resume.  A return to work depends on the patient's occupation, and there being no deterioration when normal levels of exercise are established.

Unusual circumstances, e.g.. animal bite or lick preceding an attack, or a failure of infection to respond to the above recommendations, should prompt discussions with a local microbiologist.

More information;

http://www.thebls.com/the-bls/professional-and-patients/cellulitis-in-lymphoedema/

Professionals, please contact for further information;

www.thebls.co.ukamking antibiotics for 1-2  thn changes e.g. /staining may 

Emergency Antibiotics

If your cellulitis returns, then in it makes sense to have an emergency supply of antibiotics.  Unfortunately, some GP's are reluctant to hand out emergency supplies. The risk of cellulitis returning once you have had an attack is high, therefore you should carry a two-week supply of antibiotics, especially if you are going on holiday or travel away on business.

You need;

  • Amoxicillin 500mg tds is recommended

If you allergic to penicillin;

  • Erythromycin 500mg qds or Clarithromycin 500mg bd

Start antibiotics immediately if  you have symptoms.  Always get a professional diagnosis.

Protect yourself from Inflammation

 

  • Insect bites can lead to infection and inflammation therefore use insect repellent

 

Protect from the Sun

Protect your skin from the sun by using sun cream with SPF of at least 30.

  • Protect your skin with clothes
  • Avoid sunburn
  • Please remember you can burn through clothes
  • Never use a sunbed

Heat Sources

We all tend to know the temperature of water in our own homes, but when staying with family or friends be extra vigilante.  I find the hottest water temperatures are when I stay in hotels or on holiday.          

  • Use unaffected hand to test water temperature because there might be little or no feeling in your affected hand.
  • Too much heat can increase swelling so test the water before a bath or shower. Especially when you are away from home. 
  • When you are out and about and you go to the toilet you will hopefully wash your hands after; the water from the tap can be scalding.  Sometimes you will find a notice telling you to be aware that tap water is hot but in most cases there isn't.
  • Avoid hot tubs, saunas, hot tubs and steam rooms.
  • Don't sit to near too a fire or heat source.

Manicure

I am often asked by our members whether they can have a manicure.  Several lymphoedema practitioners will tell you no.  However, by following these tips, I find that I can have a manicure;

  • Use nail clippers instead of scissors so that you are less likely to nick the skin.
  • Don't push back or cut your cuticles.  
  • If you do have a professional manicure, make sure that salon hygiene is good.
  • Make sure the product used is a reputable one.

For someone living with lymphoedema most of the above tools are something you would not want to be poked and prodded by.

What does cellulitis look like?

Cellulitis looks like

 

The above photograph was taken by an L-W-O member, reproduced with her permission.  Clare has used a marker pen so that she can show her health care professional how the infection has spread.

Elevation

When you are sitting or lying down L-W-O recommends that you can elevate your limbs so that the lymph fluid can drain.

  • Arm lymphoedema - sitting in a chair, put a cushion or pillow under your arm so that your arm is elevated.
  • Leg lymphoedema - sitting in a chair use a stool or chair to raise your leg.
  • Lying in bed - put your leg on a pillow, but do not put it higher than your head.
  • Head and neck lymphoedema -  use 2 or three pillows to raise your head this allows the lymph fluid to drain.

Thank you to L-W-O member Jessica Snee for allowing me to use this photograph.

Avoid

  • having blood pressure taken from affected limb
  • blood being taken from you affected limb
  • injections or IVS to your affected side.
  • invasivive procedures to your affected side.
  • using the arm for long periods as vacuuming, ironing, driving and gripping can all make your condition worse.  Ironing and vacuuming often take a terrible toll on my arm.
  • Carry a medical alert card or wear one of L-W-O's wristbands.

Burns

  • Avoid burns by using oven gloves or pot holders.  The advice is to wear long sleeves when cooking or baking.​

One cut

Living with lymphoedema means that you are only ever one bite or cut away from a serious infection.  Often resulting in cellulitis.

 

Always protect the skin on your hand/arm/leg to avoid cuts and scratches. The above photograph is from L-W-O member Lorraine Twinn.

Management in Hospital

Choice of antibiotics in hospital is usually made according to local guidelines. Hospital guidelines commonly recommend single agent i.v.  Flucloaxcillin 2g 6-hourly, as this is felt to cover both Staph. and Strep. infections (Leman and Mukherjee, 2005)  

If there is no or a poor response to this regimen after 48 hours, clindamycin 600mg 6-hourly iv should be substituted.   

Penicillin allergic patients should receive clindamycin  

For the treatment of ano-genital cellulitis the recommended first line treatment is amoxicillin 2g 8-hourly iv plus gentamicin 5mg/kg iv daily; dose to be adjusted according to renal function and assay. NB: Local hospital guidelines may differ from this.  

Monitoring of CRP / ESR / WCC / temperature is recommended and microbiology of any cuts or breaks in the skin before antibiotics started. Blood cultures may be appropriate.  

Extent and severity of rash – if possible, mark and date the edge of the erythema (may be difficult in lymphoedema as the rash is often blotchy).  

A switch to oral treatment with amoxicillin 500mg 8-hourly, or clindamycin 300mg 6-hourly should not be made before:   

  • ​Temperature down for 48 hours
  • Inflammation much resolved
  • CRP falling

Then continue to Antibiotics Home Management

For more information;

http://www.lymphoedema.org/index.php/ cellulitis/about-cellulitis

Cellulitis - leg

This is how lymphoedema developed in the leg of L-W-O member, Lisa West.  See how she has mapped the spread of the infection with a marker pen.

Shaving

 
  • Use an electric shaver not a razor for removing unwanted underarm or leg hair.
  • No waxing or sugaring to remove unwanted hair.
  • Always try a small test patch before using hair-removal creams.

Indentations

  • Avoid wearing tight elasticated cuffs like those you would wear when doing a sports activity.
  • Avoid wearing tight jewellery especially bracelets, rings and watches, including ankle bracelets or toe rings.
  • Avoid tight bra straps and tops with tight armholes.
  • Avoid tight clothing around the groin area.
  • Do not carry anything heavy, such as bags of shopping this could lead to muscle strain and make swelling worse.
  • Do not carry a shoulder handbag on your affected side.

Photograph of L-W-O member Christine Watson's fingers when her rings got too tight. The indentations are clear to see.

Often you can slip your rings on easily, go about your day and suddenly your fingers start to swell, then you have difficulty getting them off.  If you feel your fingers swelling, try to remove your rings as soon as possible.  I often go without wearing rings, if they don't slip on then I don't put them on.

Gardening

  • Wear long trousers to protect your legs when you are gardening or doing DIY

  • Wear gloves when gardening, doing DIY or Washing-up
 

The above poster was found on Pinterest.com

 

Page last updated 27/01/2018