Skin Care for Patients with Lymphoedema

by: J.R. Casley-Smith & Judith R. Casley-Smith (L.A.A., University of Adelaide)

Skin problems usually cause a local high-protein oedema which adds to the load of an already inadequate and over-burdened lymphatic system in a generalised high-protein oedema. Hence considerable emphasis must be given to keeping the skin as clean, healthy and supple as possible, and to avoid problems, or if they are present, to treating them and clearing them up.

Indeed skin care is the first thing that must happen when a patient comes to a clinic. This takes time so it is better to clear them up before going to a clinic; indeed, to minimise lymphoedema, it is better to clear them up as soon as possible, or avoid them.

Much can be done in the early stages of lymphoedema and to a 'limb at risk' to prevent skin problems. The skin must be kept supple and moist (see the following list of skin care products which are available or can be ordered through pharmacists). Obviously trauma to the limb (e.g. knocks, abrasions or cuts, burns - including sunburn, and insect bites) must be carefully avoided and, if they occur, treated. The limb must also be kept spotlessly clean and dried very carefully. A mineral oil cleanser is much less drying and better for the skin than normal toilet soap.

In the clinic situation where problems may already have occurred or skin changes are already present, certain other methods may be necessary to deal with the problems. It is then sometimes essential to work in conjunction with a Dermatologist since some of the conditions, especially fungal ones, can be very difficult to eradicate.

In extreme cases descaling must be done as part of the daily treatment. This involves the removal of tiny pieces of flaky, dead skin - piece by piece - thus exposing the tissue underneath and enabling infections to be more easily treated. Ulcers also pose their own particular problems and require special dressings under the bandages.

We find (coumarin, 5,6 benzo-alpha-pyrone, 56 BaP, 1,2 benzopyrone) powder and ointment are very useful in problem areas (as well as helping to reduce the lymphoedema). They reduce the inflammatory oedema associated with the condition and reduce the pain caused by lymphoedema in the skin (which compresses the pain nerve endings). They are also very helpful with the warts and fistulae so often found in lymphoedema.
Coumarin powder is also an excellent lubricant during the massage part of Complex Physical Therapy.

Products in Australia and some other countries

Below is a list of products all of which have their particular place in the care of the lymphoedematous limb. Most are products of Hamilton Laboratories, Adelaide, and are available through pharmacists. This should not be taken to mean that we necessarily believe that this manufacturer is better than others; however we use all of these products and find them excellent and of very reasonable price. We have not tried the others which may do the same job, since we are well satisfied with these. Many are available in a variety of packs, including hospital packs. Larger ones are cheaper but not always convenient.

Hamilton Sunscreen SPF 15+ (to SPF 30+)
These are a must if there is any exposure to the sun. Sunburn is very dangerous for a lymphoedematous limb. They are a total sun block (the Sunscreen milk lasts up to 4 hours). The Sunscreen also has a moisturising base which helps to maintain the skin tone. It is available as a cream, a milk, a lotion (spray) and a lipstick. All except the lotion are highly water resistant.

Stingose
This contains Aluminium sulphate and de-natures the venom or toxin of a sting (from a plant or animal) or a bite. It should be applied as soon as possible to prevent pain, excess oedema and a worsening of the lymphoedema. An excellent alternative, which works just as well, is Coumarin ointment.

The following should be used both to preserve the health of the skin, or if the skin is at all inclined to be dry, flaking or itching.

Hamilton Oil
This is a mineral oil with no added preservatives or lanolin. It lubricates and softens the skin and helps to retain moisture.

Hamilton Wash
This is used in place of soap. It is a non-lathering gentle cleanser which lubricates the skin and does not reduce its moisture content. This is paraffin oil and surfactants.

Hamilton Cleansing Lotion
This is an excellent cleanser with a mild antiseptic action. It also improves the moisture level of the skin and its tone. It contains glycerol, liquid paraffin and chlorhexidine. It should be used if normal showering is difficult.

Hamilton Body Lotion
This is a non-sticky lotion (without lanolin or perfume) which improves the suppleness and tone of the skin. It is a good lubricant for massage.

Hamilton Skin Cream
This is similar to the Lotion, but is a cream and is so more suitable for chronically dry or cracked skin, or that which is thickened, or scaling.

Hamilton Dimethicream & Hamilton Skin Repair Cream
This protects the skin from irritants, prevents moisture loss, improves tone and is a good lubricant. It contains an antibacterial (cetrimide) and silicone, and is suggested after the massage part of Complex Physical Therapy and/or before bandaging.

Hamilton Urederm
This is 10% urea in a petrolatum base. Urea is a very effective moisturiser, which improves suppleness, prevents dehydration and reduces itching. This is very effective on calloused areas.

Hamilton Dermatar
This is a pine tar preparation (without preservatives, perfume or lanolin). It helps to relive itchy skin and dermatitis. It has a gentle cleansing action and may be used added to a bath, or applied to the pre-wetted skin in a shower.

Hamilton Dermex 7A
This we find a useful adjunct, if hydrotherapy is being used, as a barrier cream, to protect the limb whilst in the pool. It is a silicon cream, of the correct pH (3.8). It is also of course advisable if the patient goes swimming at any other time - particularly in public pools. It is only used if a compression garment is not being worn.

Hamilton Pedoz (an antifungal, antibacterial powder) for tinnea. This can occur not only between the toes, but in the groin or under the breasts, etc.

Whitfield's Ointment is an old but good formulation, for tinnea, obtainable from pharmacies.

Hamilton Minidine Antiseptic - a low iodine formula solution that has a greater efficacy than ordinary Iodine or Betadine, if an antiseptic is necessary.

Hamiltons Formicare
This is a range of products for itching or inflamed skin. It includes a bath or shower solution, skin wash, skin gel and a skin relief (cream).

Hamiltons Eczema Cream
This is for the treatment of eczema or dermatitis and allied chronic inflammatory skin conditions - scales, crusts, blisters, weeping, burning and itching. (Again Coumarin ointment or powder are excellent for these also.)

Products in the U.S.A. and some other countries

Mr. R. Blake (Hamiltons) has kindly suggested similar products to the above which readily available in the U.S.A.
For Beiersdorf/Jobst ones contact Beiersdorf (B.D.F. Plaza, Norwalk, CT 06856 - 5529, USA, (203) 854 8076; Fax (203) 854 8180; Orders: 1800 BDF 2340) or Jobst (Box 653, Toledo, Ohio 43697-0653, USA; tel (419) 698 1611, fax (419) 691 4511).

For Bath Oil, use Nivea Bath Oil or Alpha Keri Oil (Jobst/Beiersdorf)

For Body Lotion, use Eucerin Moisturizing Lotion (Jobst/Beiersdorf)

For Cleansing Lotion, use Cetaphyl Cleansing Lotion (Jobst/Beiersdorf)

For Dimethicream / Skin Repair Cream, use Nivea Enriched Lotion or Lac-Hydrin

For Urederm for dry, scaly skin), a 10% urea cream should be available as one of the following: Aquacare, Aquadrate, Calmurid, or Nutraplus

For Dermex 7A {There appears to be no real equivalent, but for protection while swimming: Nivea Skin Oil or a 10% Silicone Barrier Cream are suggested.

For Tinnea, use Loprox or Tinactin powder for the shoes

This document was l was last amended on 31 August, 1995.