Common infections in lymphedema are cellulitis and erysipelas.  As with most infections, they present with redness, swelling and warmth. Pain and/or blisters may or may not be associated.

• Cellulitis is an infection of the deep subcutaneous tissue due to the streptococci bacterium (or other bacterium such as staphylococcus aureus). Cellulitis has a slower onset and the redness has an undefined, vague border. This infection is more often found in the legs.
• Erysipelas (also called St. Anthony’s fire) is an infection of the upper layers of skin that tends to recur. It is caused by the streptococcal bacterium and has a faster onset than cellulitis. The associated redness has a defined or sharp edge (like a burn) and is slightly raised. It usually begins with chills followed by a high fever and may include severe malaise (pain), nausea and headache.^{1,3, 5}
  

These two infections can co-exist as they involve different layers of the skin.  But whether there are two infections or one, in the U.S. they are commonly lumped under one umbrella and called “cellulitis.”  For our purposes, cellulitis is simply a skin infection causing redness, swelling and warmth. If you have lymphedema and you have symptoms of infection, you need to get to the doctor promptly. Each infection further damages your already impaired lymphatic system — and if left untreated, can be fatal.

How do you get cellulitis? We all have bacteria that normally live on our skin. When something causes a break in your skin (an insect bite, an animal bite, a sunburn, a scratch, a thorn, etc.), bacteria have a way inside your body. Most of the time, your immune system fights them off. But even the healthiest among us can be susceptible. In lymphedema, immunity is reduced in the involved extremity. As a result, a person with lymphedema is predisposed to getting cellulitis (recurrent infections are common in stage III lymphedema).  It’s also possible to get cellulitis and have no apparent external trauma to your skin. This may be due to skin being more permeable (such as in a distended, swollen limb). Other risk factors include being older, having a serious illness or an immunocompromised state, liver or kidney disease, venous insufficiency, ² or any condition that may impact sensation (such as neuropathy or paralysis).

How can you prevent cellulitis?  If you have lymphedema, wear your compression to control swelling. Additionally: ^{3, 4}

• Avoid skin punctures (wear gloves during gardening, don’t roughhouse with pets, use bug spray)
• Avoid scratching (try gently rubbing an itch)
• Wear gloves when working with chemicals or hot dishwater
• Wear protective mitts when working near a hot stove
• Wear a thimble if sewing
• Don’t cut cuticles and avoid nail salons
• Use sunscreen
• Treat any skin condition that may compromise your skin (such as athlete’s foot, eczema or psoriasis)
• Use more acidic soaps and lotions

In January’s blog, we’ll talk about the best soaps and lotions for lymphedema.

References
¹ British Association of Dermatologists. Cellulitis and Erysipelas. British Association of Dermatologists; 2012 (reviewed 2021); 1-5. Available at: https://www.bad.org.uk/shared/get-file.ashx?id=156&itemtype=document.
² Ki, V. Bacterial Skin and Soft Tissue Infections in Adults. Can J Infect Dis Med Microbiol. 2008 March; 19(2) 173-184. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2605859/
³ Foldi, M, Foldi, E. (2006). Foldi’s Textbook of Lymphology (2^nd ed.), p. 262-271. Germany: Urban and Fisher.
⁴ NLN Medical Advisory Committee. Summary of Risk Reduction Practices. NLN; 2012; 1. Available at: https://lymphnet.org/position-papers
⁵ https://www.merckmanuals.com/professional/dermatologic-disorders/bacterial-skin-infections/erysipelas