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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.



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FUNGAL INFECTIONS


Many people with lymphedema also have fungal nail infections













lymphedemapeople.com gotofootdoc.com



Even though the majority of the skin’s surface is on the dry side, slightly acidic and offers little nutritional value for microorganisms, it does have some well-adjusted bacteria that thrive in this environment and actually help us out. Just like our bowels have a microbiome of “good” bacteria, skin too has a colony of bacteria that are collectively known as normal flora. There is a harmonious living arrangement between the host (us) and the bacteria. However, if something occurs to disrupt this relationship, infection can occur.


There are many types of fungus. They live in dirt on household surfaces, on plants and on your skin. Fungi (Plural of fungus), live on our skin and prefer moist regions including skin folds and between the toes. In certain instances, existing fungi grow more than usual, other times fungus is transferred to your skin by other means and both cause uncomfortable symptoms and what is known as a mycosis infection.


Since having lymphedema disrupts the skin’s ability to defend itself, common infections can include athlete’s foot, toenail fungus and fungal infections in between skin folds of your lymphedema limb.


SIGNS & SYMPTOMS OF FUNGAL INFECTIONS

  • Peeling, cracking and scaly skin

  • Blisters

  • Skin breakdown that ranges from redness to open sores

  • Itching

  • Burning

Fungus grows well in moist environments. Monitor skin folds (anywhere two skin surfaces meet), in between your toes and the bottom of your feet. Toe nail fungus presents as discoloured nails that are thick and peel away from the nail bed.


PREVENTION

  1. Dry in between toes well after bathing

  2. Ensure that any skin folds are dried well after bathing and kept dry during the day. You may have to check this area more than once a day to make sure it is dry.

  3. Wear foot wear in public showers and bathrooms

  4. See a foot specialist regularly for toenail and foot care

  5. Wear clean socks daily and if they get wet, change them

  6. Wear “breathable” clothing and shoes


TREATMENT

Fungus can take some time to be rid of. See your doctor or foot specialist if you have any concerns or symptoms. Usually, a topical cream, powder or tincture is used to eliminate the infection. Some people may need oral medication.



CELLULITIS


Is a complication of lymphedema due to its diminished immune capacity. Some people have repeated bouts of cellulitis which can worsen lymphedema.




















drugs.com


Signs and Symptoms of cellulitis: (SHARP)


  1. Swelling (new or increased)

  2. Heat: the area feels hot to touch

  3. Angry, Red colour to skin

  4. Pain

Other symptoms may include fever, feeling of being unwell or nausea.


There are many skin infections that may be mistaken for cellulitis. Contact your doctor regardless to have it seen and for treatment. If you have the symptoms above, draw a line around the reddened area and seek medical help.



TREATMENT FOR CELLULITIS


ANTIBIOTICS

Treatment usually involves taking oral antibiotics. If not caught early, you may need intravenous antibiotics. Some people with lymphedema who develop cellulitis on a frequent basis have an antibiotic prescription on standby from their family doctor so that they can take their first dose right away and then call their doctor.


SILVER

Silver has been used in medicated wound healing treatments for some time and has antibacterial properties. There are some compression garments on the market that have interwoven threads of silver in their material. There have been some reports by those wearing garments that have silver in them preventing cellulitis infections. However, there are few research studies on this topic or on the long-term effects of wearing a silver garment.


Lymphedema is a life-long condition of swelling and thus requires some extra self-care measures. Monitoring your skin and being careful with skin and nail care is apart of lymphedema maintenance routines.



DISCLAIMER

The information in this blog is for educational purposes only and not meant to diagnose a problem. If you have any questions or concerns, you should always consult your doctor.


resources:

Microbes and you. https://www.scq.ubc.ca/microbes-and-you-normal-flora/

Merck manual fungus. https://www.merckmanuals.com/en-ca/home/skin-disorders/fungal-skin-infections/overview-of-fungal-skin-infections

https://www.webmd.com/skin-problems-and-treatments/guide/fungal-infections-skinWebmd.

Vitamin D: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3356951/

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