Caring for yourself is always important, but it plays an essential role both in the management of existing lymphoedema, as well as the prevention of lymphoedema in those patients at risk of developing this condition. Breast cancer patients in particular fall in this latter category.
Current methods of cancer treatment lower the risk of developing lymphoedema. However, if you have ever had surgery involving the lymphatic system – for example a radical mastectomy – even many years ago, and even if you have never had any arm swelling, the risk for developing lymphoedema will always be present.
Prevention is in your best interest!
Skin care in particular is important to help you avoid the onset of lymphoedema. Your skin is the first line of defence against foreign invaders and is usually impermeable to bacteria and other pathogens. However, any defect in your skin such as burns, chafing, dryness, torn or cracked cuticles, cracks, cuts, splinters, and insect bites can present an entry site for pathogens or infectious agents and cause infection.
Patients who already have, or have had lymphoedema are particularly susceptible to infections of the skin and nails. The reason is that lymphoedematous tissues are saturated with protein-rich fluid, which serves as an ideal nutrient source for bacteria and other pathogens. Lymphoedematous skin also tends to be dry and may become thickened and scaly, which increases the risk of skin cracks and fissures.
Inflammation may not only make lymphoedema much worse by increasing the swelling, but it can also develop into a serious medical crisis.
The basic consideration in skin and nail care, which includes proper cleansing and moisturizing, with the goal of maintaining the health and integrity of the skin, is therefore vital for the prevention and control of infections.
There are ointments and lotions especially formulated for sensitive skin, and suited to radiation dermatitis and lymphoedema. These should be applied before the application of lymphoedema bandages during the time you are in the decongestive phase of the treatment. Once the limb is decongested and you wear compression garments, moisturizing ointments should be applied twice daily.
Ointments, as well as soaps, or other skin cleansers used in lymphoedema management, should have good moisturizing qualities, be fragrance free and hypo-allergenic, with either the neutral or acidic range of the pH scale (around pH 5). To identify possible allergic reactions to skin care products, they should always first be tested on healthy skin before the initial application to areas affected by lymphoedema.
When caring for your nails, it is important to keep the risk of infections to a minimum. Finger and toe nails should be kept short using clippers (no scissors), toenails should be cut straight across, and a podiatrist should be consulted to treat and prevent ingrown toe nails. Soak clippers in surgical alcohol, or Biotane to disinfect before/after use. Cuticles on fingers and toes should never be cut, but should be pushed back with a cuticle pusher.
Please avoid gel or acrylic nails, as bacteria between the natural and artificial nails are a common cause for infections.
CARING FOR YOUR COMPRESSION GARMENTS
Tight fitting compression sleeves or stockings, as well as materials used in compression bandaging may also cause skin irritation. Some patients are allergic to a certain material used for compression therapy. This can be remedied by switching to alternative materials.
Make sure that any skin lotions used are fully absorbed before a compression garment is used. Cornstarch powder helps you to don a garment much more easily. Use a gentle washing powder/ liquid and lukewarm water to wash your garment. When drying it, do so inside. Never expose the garment to full sunlight.
QUICK SKIN CARE GUIDE
- Cleaning the skin – use a mineral oil based cleanser or glycerin soap – must be pH balanced
- Soap substitutes: Eucerin bath therapy, Cetaphil
- Daily application of lotion – low pH (ideal is 5.5), fragrance free
- Moisturisers: Eucerin, Nutraderm (lotion and cream), Johnson’s Naturals: Baby soothing intensive moisture cream
- Sun screen – SPF 40 or higher, eg Bioderma
- Shaving – use an electric razor for shaving
- Nail care – take care when treating cuticles.
- See podiatrist for difficult toenails. Soak clippers in surgical alcohol, or Biotane to disinfect before/after use.Fungal infections – if topical ointments do not work, consult a doctor for oral medications.
- Preventative – alternate pairs of shoes, and dust inside with anti-fungal powder. Always dry thoroughly between the toes.
- Itchy areas – use hydrocortisone cream (you will need a prescription for this). Do not scratch the skin!
- Take immediate care of any cuts, scratches, bites or other skin breaks –carry alcohol swabs (eg Webcol), a liquid skin barrier, antibacterial ointment and/or bandaids at all times.
- Insect repellant – to avoid mosquito or bug bites, which are a common cause for infections. Do not scratch! (NB – do not use on or under a compression garment)