Management of chronic oedema consists of identifying and eliminating risk factors where possible e.g. prolonged dependency, obesity, sedentary lifestyle. A combination of preventative and active therapy includes compression, skin care, exercise, healthy lifestyle.
Exercise is important for assisting the natural venous and lymphatic return. Whilst elevation may help in the short term, the pumping action of the muscles squeezes the lymphatic and venous vessels forcing blood and lymph out of the leg and back to the heart. Exercise also enhances the effects of bandaging on the muscle pump. Type and frequency will depend on need, ability and general health, and increased at a pace that is tolerable. Patients who have difficulty moving their limbs can be exercised passively. Compression should be worn during exercise.
Exercise is also important for maintaining a healthy lifestyle. Other factors contributing to good chronic oedema health are: maintaining a healthy weight, going to bed at night (instead of sleeping in a chair), avoiding static activity, footwear that supports the ankle and covers the whole of the foot. Prescribable footwear e.g. Kerraped is available to accommodate compression bandaging. Ill-fitting shoes can cause trauma to the skin which may lead to cellulitis, increase the risk of falls, allow foot swelling to increase.
Follow the links for more information on Compression – either hosiery (garments) or compression bandaging.
Skin Care
Skin care is important to:
- Reduce the risk of developing cellulitis.
- Keep the skin soft and supple
- Prevent the skin from becoming dry and cracked
Daily skin care should include: observation, cleansing and moisturising.
There is a wide range of cleansing and moisturising agents available, but the regimen should be individualised based on patients’ needs. Further skin care information can be found via:
- Lymphoedema Support Network
- Macmillan lymphoedema project for Scotland – Top tips for the self management of lymphoedema – A guide.
Special Skin Problems that Can Occur in Chronic Oedema
Dermatitis and eczema are terms used to describe a common inflammatory skin condition which is characterised by red, itchy, weeping skin. This skin condition can lead to scratching, which can result in breaks in the skin, and infection could occur. Dermatitis can be due to allergens and this is why bland, unscented emollients should be used to reduce the risk of allergic reaction.
Fungal infections are common in chronic oedema. If untreated, they can lead to infections such as cellulitis. If fungal infections develop between the toes, it is important that the GP is consulted to prescribe the correct anti-fungal treatment, to treat this quickly and efficiently.
Lymphorrhoea is the term used to describe the leaking of lymph fluid through the skin surface. This could occur if the limb swells suddenly, if the skin is not kept soft and supple, or if the skin becomes thin and fragile. The risk of infection increases if lymphorrhoea is present. Appropriate treatment should be sought by an qualified practitioner, should lymphorrhoea develop.
Cellulitis
Refer to the BLS Consensus document
Varicose Eczema
Consider treatment with Betnovate C Ointment
Further information and learning resources can be found at this informative site: www.healthy-legs.co.uk
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