SKIN INFECTIONS & LYMPHEDEMA:
Updated: Feb 21, 2022
The skin’s ability to defend is weakened
THE SKIN
The skin is the largest organ of the body and is referred to as the integumentary system. The skin has 3 main layers that sit above muscle. The bottom layer is the subcutaneous tissue also known as the hypodermis which contains fat cells that provide insulation and acts as a shock absorber.
← HYPODERMIS (FAT LAYER)
The middle layer known as the dermis is where the bulk of the action takes place. In this layer you will find blood vessels, sensory nerve endings, immune cells, sweat glands, hair follicles, lymphatic vessels and various types of connective tissue that help to support this layer such as collagen, elastin and fibrin (we all know from skin care advertisements that loss of collagen and elastin as we age causes wrinkling- hence we lose the support structures that hold our skin taught and make it springy).
← THE DERMIS
The epidermis is the name given to the top few layers of skin. The lower portion of this layer (the purplish layer) contains cells that constantly make new skin cells called keratinocytes. They are pushed to the surface of our skin ( the brownish layer) as new cells are made and constantly shed as new ones migrate to the surface from below. Acting like a roof on a house, these cells do not allow water to enter, but do allow creams and medicines to be absorbed.. Also, within the lower part of the epidermis we find melanocytes that give us our skin pigmentation and it is in this layer also that the initial Vitamin D production begins after exposure to sunlight.
）← THE EPIDERMIS
CHANGES THAT OCCUR WITH LYMPHEDEMA
The lymphatics within the dermis are responsible for removing proteins, wastes, unwanted particles and fluid. Having lymphedema means that this process becomes less effective as lymphedema progresses to more severe stages. Therefore, the wastes, proteins, unwanted particles and fluid remain in the tissue creating a sludge of sorts that the body has to deal with. This post deals with infection of skin layers, I can make a whole new blog post about skin changes that occur due to lymphedema.....watch for it!
Photo by Yogendra Singh from Pexels
Essentially, when the lymphatic channels are disrupted, the skin’s ability to defend itself becomes impaired.
INFECTION AND LYMPHEDEMA
Skin irritation and an infection can be complications associated with the inability of the lymphatics to clear the area and how it responds to their presence in the tissues.
The body’s response to anything unwanted involves a whole host of chemical reactions that either immediately attack, or send signals to other cells to do the job. In some cases these chemicals can cause itchiness, redness or pain in the area and become bothersome to the individual experiencing them. Overgrowth of bacteria or fungi can cause skin infections and some bacterial infections can cause serious health concerns such as with cellulitis.
FOOT CARE WITH DIABETES vs FOOT CARE WITH LYMPHEDEMA
Complications of having diabetes for many years result from nerve and blood vessel damage due to fluctuations in blood sugar levels. These complications include delayed wound healing, increased risk of infection from even minor cuts and scrapes, stiff arteries and arterial insufficiency and a condition called peripheral neuropathy which causes numbness and tingling in the feet, a decrease in sensation and balance problems. Those with severe peripheral neuropathy may not feel cuts, scratches, scrapes, bumps or other such trauma to their feet. Many people have diabetes and also have lymphedema.
Many people with foot swelling due to lymphedema have similar sensation difficulties and have an increased risk of infection because fluid in the tissues is a great growth medium for bacteria. Many people with leg swelling are unable to visualize, reach or care for their feet due to a variety of reasons. Therefore, the evidence-based practices that are suggested to people with diabetes may also apply to those with lymphedema.
Here is a link to a pdf sheet on self foot care for diabetics. For those who have lymphedema, it is not a bad idea to follow these guidelines as well.
https://guidelines.diabetes.ca/docs/patient-resources/foot-care.pdf
Taking care of your fingernails for those with arm and hand lymphedema is just as important. Monitoring your nails for signs of fungus and carefully maintaining nails and cuticles is all part of preventing infection.
I would suggest to those of you who have diabetes, thick and difficult to cut nails or those who have difficulty bending over, reaching your toes or have difficulty with using nail clippers that you seek nail care by a professional. But, who do you go to? Here is a list of potential options:
a. a nurse that specializes in foot and nail care
b. a chiropodist: a diploma prepared foot specialist not covered by OHIP that can do special procedures on the foot, but not surgery. No physician referral is needed.
c. a podiatrist : a doctor of podiatric medicine covered by OHIP and can perform surgery on the foot. No physician referral is needed.
SUBSCRIBE TO THE WEBSITE AND WATCH FOR THE UPCOMING PDF VERSION OF YOUR SKIN AND NAIL CARE CHECK-OFF LIST!
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FUNGAL INFECTIONS
Many people with lymphedema also have fungal nail infections
