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Cellulitis in lymphoedema

This information has been reproduced from the LSN fact sheet ‘What is cellulitis’ which was produced and verified by accepted experts in their field and reflects current practice. The information has been designed to assist you in managing your condition and is not intended to replace advice you may receive from your health care practitioner. If you, or your health care practitioner would like further information, to ask any questions about this information or to find out what research underpins it, please contact the Lymphoedema Support Network on 020 7351 4480. The cellulitis consensus document, linked below, is reviewed in October each year.

What is cellulitis?
Cellulitis is a sudden, non contagious infection of the skin, characterised by redness, swelling and heat, accompanied by pain and tenderness. People with lymphoedema are particularly susceptible to cellulitis because the lymphatic system is damaged or overloaded and does not function adequately to fight infection.
What causes cellulitis?
The infection may enter via a break in the skin, such as a scratch or insect bite or through a pre-existing wound or ulcer, or through an area of skin inflammation, e.g. athlete’s foot, eczema or dermatitis. However, it may not be possible to identify the cause and an attack may arise without warning.
How can I recognise cellulitis?
The patient often feels unwell, as if ‘flu is starting. Symptoms can include fever, shivers, muscular aches and pains, headache, nausea, vomiting etc. The swollen area usually develops a rash or becomes red, hot and tender to the touch. Swelling may dramatically increase and pain may occur in the swollen area, or the armpit, with lymphoedema of the arm, or groin with lymphoedema of the leg.
What should I do if I develop cellulitis?
Contact your doctor immediately as you will need antibiotic treatment. Treatment of cellulitis in lymphoedema is very important, not only because the sufferer may become very ill, but because lymph drainage routes risk being damaged further, in which case, the swelling may worsen and permanent skin changes, e.g. thickening, may result. This does not help the long-term management of the condition.
For information on the type of antibiotics used in the treatment of cellulitis in lymphoedema, see the Cellulitis Consensus Document (in pdf format).
• Patients with severe constitutional upset may require admission to hospital for intra-venous antibiotics
• Those people familiar with attacks and who have appropriate oral antibiotics to hand should commence the course immediately
• Remove all compression garments until the area feels better and they can be tolerated again
• Other forms of treatment such as Manual Lymphatic Drainage and exercise programmes should be temporarily suspended
• Rest with the affected limb elevated in a comfortable position, ideally raised to the same level as the heart
• Drink plenty of water
• Paracetamol may be taken, however, anti-inflammatory medications such as ibuprofen should be avoided.
For more information, see the LSN fact sheet, ‘What is cellulitis’

Denise Hardy, LSN Nurse Advisor

Last reviewed March 2015
Next planned review March 2017
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