Can lymphedema cause skin issues ?

What is lymphoedema?

Lymphedema is a disease that causes an arm or a leg to become larger because the lymphatic system does not work properly. In women treated for breast cancer, it is the most common complication, especially after surgery with removal of lymph nodes under the arm, radiotherapy or chemotherapy⁽¹⁾.To find out more, read our article about lymphoedema after breast cancer here.

Contrary to what people may think, the swelling is not only due to a build-up of Lymph. When lymph does not move well, it can quickly start a chain reaction in the fabrics. Inflammatory cells can stimulate fibroblasts. These cells then produce too much collagen^(1,4). This collagen can slowly thicken the skin and cause an increase in fatty fabric⁽¹⁾ (an increase in the size of fat cells). Over time, fibrosis can develop around the fat cells. This makes the fabrics more and more stiff and difficult to treat.

These deep changes in the fabrics are directly linked to the skin complications seen in patients: tight skin, thicker skin, and less soft^(1,4). 

What are the possible complications of lymphoedema?

The lymphatic system, where lymph moves, normally helps the body remove extra large proteins and water found Between the cells. It also has a role in the body’s immune defences^(2,5). When lymphedema happens, lymph builds up between the cells and under the skin and is not drained correctly.

When this fluid stays for a long time, substances can build up (proteins and other waste that the body needs to remove, which may support local inflammation and the growth of bacteria). The activity of immune cells, which help protect the body, is reduced, which lowers the local immune response⁽⁵⁾.

Over time, the skin becomes less elastic and thicker, and then has more difficulty with its barrier Function against pathogens.

What skin problems are caused by lymphoedema?

This slowing of lymph flow affects local immunity: the skin becomes more open to infections, especially those caused by streptococci⁽³⁾. When these streptococci are no longer controlled by the skin’s immune system, an infection may appear⁽³⁾.

Erysipelas is the most common and most feared complication. It is a bacterial infection encouraged by wounds (cuts, scratches, irritation or fungal infections Between the toes caused by fungi) and marked by a high fever, red skin, pain, heat and swelling of the affected limb^(2,3). It is therefore essential to protect the skin of the affected limb, to thoroughly disinfect and clean the wound to minimise the risk of infection, and to seek urgent medical attention if you develop a fever or sudden redness.

Other skin changes appear gradually as the disease progresses:

Hyperkeratosis⁽⁴⁾ means a thickening of the top layer of the skin. The skin becomes rough, dry and flaky, and may look like paving stones or scales. Cracks may form, further increasing the Risk of infection⁽⁴⁾.

The increase in the thickness of skin folds is another visible sign. The natural folds of the skin become thicker and deeper, making local hygiene more difficult and encouraging moisture build-up⁽⁵⁾.

Skin fibrosis⁽⁵⁾ means gradual hardening and thickening of the fabrics under the skin. Too many collagen fibers are produced, making the skin and deeper fabrics more and more stiff, painful and difficult to move.

Papillomatosis⁽⁴⁾ is an advanced form of skin change. It appears as raised growths with a wart-like look, caused by long-term inflammation and lasting lymph blockage. These lesions make hygiene care more difficult and increase the risk of another infection.

The final stage of all these changes leads to elephantiasis, also called pachydermia⁽⁵⁾: the affected limb becomes much larger, with thick, fibrous and deformed skin, making any movement extremely difficult.

Prevent and treat skin infections

Prevention of skin infections, such as erysipelas, linked to lymphedema is based on strict body hygiene, as well as systematic disinfection of wounds and careful monitoring of any skin injury, even minor⁽³⁾.

Prevention is therefore based on:

• Careful skin hygiene^(3,4) 
• Immediate disinfection of wounds⁽³⁾
• Treatment of fungal infections⁽³⁾
• Daily moisturising of the skin⁽⁴⁾
• Wear of compression garments and compression bandages may also be advised on the affected limbs, to regulate lymphatic flow and limit the development of skin changes⁽⁴⁾

Antibiotics

Preventive use of antibiotics may be considered in some cases, especially for patients with frequent recurrences. Early diagnosis and treatment may help avoid very difficult treatments, such as antibiotics given through a vein, or hospitalization.

As feet are especially exposed to fungal infections, antifungal products may be applied to them⁽⁴⁾.

If you have any other questions, ask your doctor for advice.