Cellulitis ,first aid for those with lymphedema, emergencies relate Infections Related to Lymphedema Introduction Serious infections that can develop within the affected tissues are a serious complication associated with lymphedema. The risk of infection increases when lymphedema is not controlled by proper treatment and appropriate precautions. The risks of lymphedema related infections are due to: The swelling of lymphedema compromises the health of the skin. Healthy intact skin is the body’s primary line of defense against invading pathogens. Normal skin is protected by a film known as the acid mantle. The acidic nature of this film discourages such pathogens. When skin is swollen, the acid mantle is disrupted and is not as effective in stopping invading pathogens. Protein-rich stagnant lymph within these swollen tissues creates an environment that pathogens love! This lymph has nutrients that allow the pathogens to thrive. This stagnant lymph can also contain pathogens and damaging toxins that should have been removed by the normal flow of lymph. The deep skin folds resulting from the lymphedema are an ideal breeding ground for fungal infections. The area within the folds in warm, moist, and dark. This creates an ideal environment for fungi such as tinea pedis (athlete's foot) and tinea cruris (jock itch). Cellulitis Cellulitis (sell-you-LYE-tis), also known as lymphangitis, is an infection that spreads freely, quickly, and uncontrollably within the deeper tissues of the skin. Cellulitis becomes a life-threatening emergency when it spreads through the lymphatic or circulatory systems and can reach vital organs and other body parts. This type of infection requires prompt treatment with antibiotics. Cellulitis is usually caused by the bacteria staphylococcus aureus that normally live on the skin. Any break in the skin, no matter how small, provides an opening for them to march in, multiply, and thrive. Even a simple act such as shaving a swollen leg could be an invitation to infection. Symptoms of Cellulitis Malaise (a general sense of not feeling well) Flu-like symptoms Chills and fever Discoloration (redness, or streaky red lines) Rash Tissues that feel hot and tender Sudden swelling Itching Pain Erysipelas Erysipelas is visible just below the ankle bone. Erysipelas (er-ih-SIP-eh-las) is a painful skin infection that affects the skin plus the subcutaneous tissues and lymphatic structures that are located just under the skin. This is in contrast to cellulitis which thrives within the deeper tissues; however, erysipelas also requires prompt treatment with antibiotics. Erysipelas is caused by the bacteria Streptococci. These pathogens, which normally live harmlessly on the skin, can enter through any break in the skin such as a scratch, pinprick, or the cracks caused by athlete’s foot. Erysipelas invades rapidly and spreads through the lymphatic vessels. This damages the lymph vessels and increases the formation of fibrosis in the affected tissues. This damage further disrupts the flow of lymph. Erysipelas, which is one of the most common complications of lymphedema, tends to recur and there appears to be a correlation between the frequency of erysipelas infection and the stage of lymphedema. Symptoms of Erysipelas An expanding area of redness of the skin that most often occurs in the region of the ankle Itching Pain High fever, and chills Swelling and tenderness of the regional lymph nodes. Lymphangitis Lymphangitis (lim-fan-JIGH-tis) is an infection involving the lymphatic vessels that is most commonly caused by the spreading of an acute streptococcal or staphylococcal infection of the skin. The presence of lymphangitis suggests that an infection is progressing and should raise concerns of spread of bacteria to the bloodstream. Known as sepsis, a bacterial infection in the bloodstream can spread to all of the body systems within a matter of hours. Therefore, at the first signs of lymphangitis, you should seek medical treatmentimmediately . Symptoms of Lymphangitis Malaise, loss of appetite, headache, and muscle aches Red streaks from infected area to the armpit or groin (These may be faint or obvious) Swollen lymph nodes Chills and fever Fungal Infections Fungal infections occur most often when the genitalia, legs and feet are affected by stage 2 or stage 3 lymphedema. Athlete’s Foot, which is caused by the fungus tinea pedis, occurs on the feet and between the toes. Jock itch, which is caused by the fungus tinea cruris, thrives in the genital area. These infections occur when the right combination of conditions exists including A warm, dark humid environment, such as between the toes. Any change in the health of the skin. Lowering of the body's natural resistance. Tinea Pedis Symptoms Pain, burning, and itching Drying, cracking, and scaling of the skin Blistering Swelling These infections are difficult to treat and prevention is the best approach. This includes: maintain cleanliness by changing shoes and socks as often as necessary; controlling moisture by using an antiperspirant powder or spray; and routinely using an antifungal ointment, and/or powder as recommended by your healthcare provider. Jock itch can be treated with over-the-counter ointments; however, it is advisable to see your physician for professional advice. Once the condition is under control, antifungal powders or sprays may be recommended for daily use as a preventive measure. ==================================== ============================================================== Cellulitis is a spreading bacterial infection of the skin and the tissues immediately beneath the skin. Cellulitis may be caused by many different bacteria; the most common are those of the Streptococcus species. Streptococci spread rapidly in the skin because they produce enzymes that hinder the ability of the tissue to confine the infection. Staphylococcus bacteria can also cause cellulitis, as can many other bacteria, especially after bites by humans or animals or after injuries in water or dirt. Bacteria usually enter through small breaks in the epidermis that result from scrapes, punctures, burns, and skin disorders such as dermatitis (see Itching and Noninfectious Rashes: Dermatitis). Areas of the skin that become swollen with fluid (edema) are especially vulnerable. However, cellulitis can also occur in skin that is not overtly injured. Symptoms and Complications Cellulitis most commonly develops on the legs but can occur anywhere. The first symptoms are redness, pain, and tenderness over an area of skin. These symptoms are caused both by the bacteria themselves and by the body's attempts to halt the infection. The infected skin becomes hot and slightly swollen and may look slightly pitted, like an orange peel. Fluid-filled blisters, which may be small (vesicles) or large (bullae), sometimes appear on the infected skin. Erysipelas is one form of streptococcal cellulitis in which the skin is bright red and noticeably swollen and the edges of the infected area are raised. The swelling occurs because the infection blocks the lymphatic vessels in the skin. Most people with cellulitis feel only mildly ill, but some may have a fever, chills, rapid heart rate, headache, low blood pressure, and confusion. As the infection spreads, nearby lymph nodes may become enlarged and tender (lymphadenitis). Other complications—lymphangitis (see Lymphatic Disorders: Acute Lymphangitis), skin abscesses (see Bacterial Skin Infections: Skin Abscesses), and spread through the blood (sepsis (see Bacteremia, Sepsis, and Septic Shock: Bacteremia and Sepsis)—are also possible. When cellulitis affects the same site repeatedly, especially the leg, lymphatic vessels may be damaged, causing permanent swelling of the affected tissue. Diagnosis and Treatment A doctor usually diagnoses cellulitis based on its appearance and symptoms. Laboratory identification of the bacteria from blood, pus, or tissue specimens usually is not necessary unless a person is seriously ill. Sometimes, doctors need to perform tests to differentiate cellulitis from a blood clot in the deep veins of the leg (deep vein thrombosis (see Venous Disorders: Deep Vein Thrombosis (DVT)), because the symptoms of these disorders are similar. Prompt treatment with antibiotics can prevent the infection from spreading rapidly and reaching the blood and organs. Antibiotics, such as dicloxacillinSome Trade Names DYCILL DYNAPEN PATHOCIL or cephalexinSome Trade Names KEFLEX , that are effective against both streptococci and staphylococci are used. People with mild cellulitis may take antibiotics by mouth; those with rapidly spreading cellulitis, high fever, or other evidence of serious infection often receive intravenous antibiotics. Also, the affected part of the body, when possible, is kept immobile and elevated to help reduce swelling. Cool, wet dressings applied to the infected area may relieve discomfort. Symptoms of cellulitis usually disappear after a few days of antibiotic therapy. However, symptoms often get worse before they get better, probably because with the death of the bacteria, substances that cause tissue damage are released. When this occurs, the body continues to react even though the bacteria are dead. Antibiotics are continued for 10 days or longer even though the symptoms may disappear earlier. =========================================== =========================================================== First Aid for those with Lymphedema Introduction The minor cuts, bumps, and scratches that are part of everyday life are not necessarily a medical crisis for those with, or at risk of developing, lymphedema. However, these minor injuries require prompt treatment with appropriate first aid procedures. After you have treated the injury, continue to check frequently for indication of infection throughout the healing stage. If any of the signs or symptoms of infection develop, seek medical treatment immediately. [1] Minor Cuts or Scratches Bleeding helps to clean out wounds, and most small cuts or scrapes will stop bleeding in a short time. If the bleeding does not stop in a timely manner, seek medical care. Never apply hydrogen peroxide or iodine solution to an open wound. because these substances are toxic to the cells of a wound that is healing.[2] Instead carefully clean the wound with mild antibacterial soap and water or with the solution recommended by your doctor. Apply an over-the-counter topical antibiotic cream, such as Neosporin.® (Note: Some physicians do not recommend using antibiotic cream for this purpose. It is prudent to get guidelines from your physician before you need to take action.) Place a sterile bandage over the wound. A band-aid usually serves nicely for this purpose. For very sensitive skin, use Duoderm® or another brand of bandage tape designed for this purpose. If tape cannot be tolerated, place gauze pads and cover them with rolled gauze that is taped to itself. Bruises Do not place ice directly over the injured area. If the bruise is on, or near, a lymphedema-affected limb examine the injured area carefully to determine that it is only a bruise with no break in the skin. If the skin is broken, treat this injury as a cut or scratch. If the skin is not broken, reduce swelling and minimize discoloration, by immediately placing a cold pack on the injury. Keep this in place for no longer than 20 minutes at a time. The standard recommendation for treating bruises includes alternating ice and heat for the next 48 hours; however, since heat is not recommended on lymphedema-affected tissues, this step should be modified to alternate cold with mild to moderate warmth. Itchy Rashes Don’t scratch is the first rule of dealing with an itchy rash, such as poison ivy. Over-the-counter anti-itch ointments, such as Cortaid®, may help relieve the itching. If the itching is severe, seek medical help. If blisters are present, do not break them. Instead treat the rash by cleaning the area and gently applying an antibiotic cream. Watch for trouble! The irritants that are producing the rash may cause increased swelling in the affected area and there is always the possibility of an infection. Insect Bites or Stings When an insect bites, it injects a toxin into the skin and these toxins cause the resulting itching. The reaction in lymphedema-affected tissues to insect bites can potentially be severe. In response to the bite, there may be a temporary increase in the swelling of the affected limb. Also, it may take lymphedema-affected tissues longer than normal tissues to clear this substance from the body. If you have multiple bites on an affected limb, seek medical advice immediately. Don’t scratch!! A cool wet cloth or cold pack will ease the itching and swelling. If the itching is severe, seek medical help. As long as there is no infection present, it should be safe to perform self-massage to help the body clear toxins from this area. An insect bite is a break in the skin and it should be treated as such. See instructions for treating Minor Cuts and Scratches. Burns Do not place butter, oil, ice, or ice water on burns is the primary rule of treating burns. Beyond that, burns are treated according to their degree of severity and the amount of body area that has been burned. [3] Extra caution should be taken when dealing with a burn on lymphedema-affected tissues. First degree burns have no blisters and there are no breaks in the skin. This type of burn is treated by cooling the burned area by applying a cold, wet cloth for 20 minutes and then removing it for 20 minutes. Repeat this until the area is pain-free. Apply a low pH moisturizer, or an antibiotic cream, over the burn to prevent the burned tissues from drying out. Provide additional protection over the affected area by covering it lightly with a dry gauze bandage. Second degree burns have blisters and superficial damage to the outer layer of skin. As long as the burn does not cover a large area, and the blisters do not break, it can be treated in the same way as a first degree burn. However, it is important to watch closely for any indication of breaking blisters and/or infection because these require prompt medical treatment. Third degree burns causes blistering and damages the deeper layers of the skin. This type of burn, particularly on lymphedema-affected tissues, requires immediate medical treatment. ====================================== = =============================================================== Emergencies Related to Lymphedema Any sign of an infection in a limb that is at risk for developing lymphedema can be an emergency and requires immediate medical attention! Introduction For many individuals the diagnosis of lymphedema comes only after a lymphedema related infection. Since these infections can quickly develop into a life-threatening emergency, it is important that anyone who is at risk for developing lymphedema should know how to recognize, and react, to such an emergency. If you are at risk for lymphedema, you need to be aware of the following basic information. Warning Signs Gradual swelling, a feeling of heaviness, and discomfort in the affected limb are often the first symptoms of lymphedema. These signs are a wake-up call that you need to seek a diagnosis and treatment soon; however, these warnings are often overlooked. For more information, read the article Warning Signs of Lymphedema. A Lymphedema Related Infection The fluid that causes the swelling of lymphedema is protein-rich and this creates an environment that bacteria love! Any break in the skin, even an insect bite, allows bacteria to gain access through the skin and to happily set up housekeeping within the affected tissues. If untreated, these infections can spread rapidly through the tissues, past the lymph nodes, and into bloodstream. When this happens, you could be faced with a rapidly spreading life-threatening emergency that can require weeks of hospitalization while it is treated with antibiotics. To learn more about these infections, read the article Infections Related to Lymphedema. Signs and Symptoms to Watch For Malaise (a sense of not feeling well). Chills and fever Achy flu-like symptoms Discoloration (generalized redness or streaky red lines) A rash The tissues feel hot and tender Sudden swelling Itching Pain Take Action Immediately! Don’t wait! This type of infection can spread rapidly and requires prompt treatment with antibiotics. If you have any of these symptoms in an “at risk” limb, seek medical care immediately. If your physician is not readily available, go to the nearest emergency room (ER). When you check-in for treatment be sure to mention that you are at risk for lymphedema!