What is lymphoedema? How does it differ from oedema? What are the causes and complications of this often-debilitating condition? Explore the insights from healthcare professionals on managing lymphoedema and its associated risks.

Understanding Lymphoedema: The Lymphatic System Explained

Lymphoedema is a condition that arises due to the failure of the lymphatic system to maintain fluid equilibrium in the body’s tissue spaces, resulting in swelling or oedema. The lymphatic system is a network of fine drainage channels that work to remove excess fluid, waste products, and other substances from the body.

The lymphatic system has three main functions: maintaining the balance of fluid in the body, absorbing specific dietary fats from the intestines, and acting as an immune defense by stimulating an immune response. When this system is disrupted, it can lead to the development of lymphoedema.

Distinguishing Oedema from Lymphoedema

Oedema and lymphoedema are often mistaken for one another, but they have distinct differences. Oedema is a result of a problem with another system in the body, such as heart failure, which can lead to swelling in the legs, feet, and ankles. In contrast, lymphoedema is a direct consequence of damage to the lymphatic system, leading to the accumulation of fluid in the tissue spaces.

Causes and Complications of Lymphoedema

Lymphoedema can be primary, meaning it is present from birth, or secondary, often caused by damage to the lymphatic system during cancer treatments. Certain types of cancer, such as melanoma, gynaecological cancers, and genitourinary cancers, are particularly associated with an increased risk of developing lymphoedema.

One of the most serious complications of lymphoedema is the increased risk of developing cellulitis, a skin and subcutaneous tissue infection caused by Group A Streptococcus bacteria. This infection can present quickly and lead to symptoms such as redness, pain, increased swelling, and heat.

Managing Lymphoedema: Strategies and Interventions

While there is no cure for lymphoedema, the condition can be effectively managed through a variety of interventions. Healthcare professionals, such as lymphoedema nurses, play a crucial role in educating patients and providing the necessary support and resources to manage this condition.

One important initiative is the Cellulitis Alert Card, a joint effort between healthcare providers and organizations like the British Lymphology Society. This card helps inform patients with lymphoedema about their increased risk of developing cellulitis, enabling them to seek prompt medical attention if symptoms arise.

Empowering Patients through Awareness and Education

Lymphoedema is often a misunderstood and debilitating condition, but healthcare professionals are working to change that. Through initiatives like World Lymphedema Day, they are raising awareness and providing educational opportunities to help healthcare providers and patients better understand and manage this condition.

By making every contact count, nurses and other healthcare professionals can play a vital role in empowering patients and improving their quality of life. By fostering a better understanding of lymphoedema and its associated risks, we can work towards improving the lives of those affected by this often-overlooked condition.

The Importance of Lymphoedema Awareness and Education

Educating the global healthcare workforce about lymphoedema is a significant challenge, but one that is being addressed through various awareness campaigns and initiatives. World Lymphedema Day, observed on March 6th, is a prime example of how healthcare professionals are working to raise awareness and provide educational resources to both providers and patients.

By recognizing the importance of conditions like lymphoedema, which can have a profound impact on a person’s life, healthcare professionals are in a unique position to make a difference. Through their efforts to educate and empower patients, they can help improve the quality of life for those living with this often-debilitating condition.

Conclusion

Lymphoedema is a complex and often misunderstood condition, but through the efforts of healthcare professionals and awareness initiatives, progress is being made. By understanding the lymphatic system, the differences between oedema and lymphoedema, and the various causes and complications of this condition, we can work towards better managing and supporting those affected by lymphoedema.

Through the continued education and empowerment of both healthcare providers and patients, we can strive to improve the lives of those living with this condition and reduce the burden it can have on individuals and their families.

Lymphoedema… It’s not just about ‘leaky legs’ – The Queen’s Nursing Institute

In the first of a two-part blog Lindsey Lister, Lymphoedema Nurse Specialist and Catherine Best, Practice Educator at Saint Catherine’s Hospice in Scarborough provide insight into the often-debilitating and hidden impact of lymphoedema – a condition commonly known as ‘leaky legs’.

Introduction

Educating the global healthcare workforce is a significant challenge, made easier by the numerous awareness days and weeks throughout the year. 2022 is no exception, with cervical cancer prevention week and Dry January being recognised in January and World Cancer Day and Eating Disorders Awareness Week in February, the earlier we are able to get the message out there, the sooner we can make a difference.

Although it is evident that we still have a long way to go before we can say we have conquered many of the debilitating non-communicable diseases that exist today, nurses and other healthcare professionals are in a unique position to make a difference by making every contact count. Due to its frequently misunderstood and debilitating impact on a person’s life, one such condition that requires special attention is lymphoedema.

Lymphoedema Day is recognised across the World on 6^th March, and healthcare professionals are being provided with the educational opportunities and resources to make a difference in the lives of those we serve. 2022 is the 7th year of World Lymphedema Day, the aim of which is to educate the world of the various significantly debilitating diseases linked with lymphoedema, including:

• primary and secondary lymphoedema
• lipoedema
• lymphatic filariasis
• lymphatic malformations
• the full continuum of diseases impacted by the lymphatic system.

So, what is lymphoedema?

Lymphoedema occurs as a consequence of the lymphatic system failing to control the fluid equilibrium in the tissue spaces, resulting in oedema or swelling as it is frequently known. Any area of the body can be affected, although most commonly it occurs in the upper and lower limbs. Lymphoedema is categorised into Primary and Secondary types. There is no cure, but the condition can be managed.

The Lymphatic System

Understanding how the lymphatic system works can help you to understand why lymphoedema occurs and why treatment needs to be specific to individual need. The lymphatic system is a network of fine drainage channels located around the body the aim of which is to remove excess fluid and waste products via a sticky colourless fluid called lymph and has 3 main functions:

• maintain balance of fluid by its mobilisation to the circulation from the interstitial spaces
• absorption of specific dietary fats from the intestines into the circulation
• acts as an immune defence by stimulating an immune response through mobilising antigens and removal of defective and non-functioning cell tissue

What is the difference between oedema and lymphoedema?

Lymphoedema occurs as a result of direct damage to the lymphatic system, whereas oedema happens as a result of a problem with another system of the body, which has an effect on the lymphatic system; for example, heart failure can lead to oedema in the legs, feet and ankles.

Often associated with breast cancer, due to the damage which can occur to the lymphatic glands during treatment, lymphoedema can also be associated with a variety of complications associated with other treatment regimens and includes particular risks associated with:

• melanoma skin cancer
• gynaecological cancers – such as cervical cancer and vulval cancer
• genitourinary cancers – such as prostate cancer or penile cancer

But it’s not just treatment regimens that can cause problems. Lymphoedema itself can lead to problems such as cellulitis also known as erysipelas – an infection of the skin and subcutaneous tissues, the main culprit being that of Grade A Beta-haemolytic Streptococcus, which occurs as a result of impaired immunity and lymphatic drainage. An incidence may present within minutes and remain low grade for a couple of weeks before visible symptoms occur; symptoms which include:

• redness
• pain
• increased swelling
• heat

In order to harmonise treatment regimens, a consensus on the treatment of cellulitis was agreed by the British Lymphology Society in 2016 and remains in use today. The British Lymphology Society also works to support healthcare professionals through their EveryBodyCan Campaign to give those who are at risk of developing lymphoedema and those who have a diagnosis, with the encouragement they need to become and remain active throughout their life.

Cellulitis Alert Card

Patients who are registered with the Lymphoedema Service at Saint Catherine’s Hospice in Scarborough receive the Cellulitis Alert Card highlighting they have damaged immune systems, which increases their risk of developing cellulitis. The card is a joint initiative introduced in 2019 by the Lymphoedema Support Network and British Lymphology Society, providing useful information that may inform the healthcare professional of the management of cellulitis in lymphoedema.

Red legs

Red legs is a condition associated with chronic oedema and lymphoedema, characterised as redness of the skin presenting bilaterally and below the knees. Commonly caused by conditions such as venous eczema and lipodermatosclerosis. It can be confused with cellulitis and treated with antibiotics unnecessarily. The Red leg pathway is a resource that can help guide direct a clinician toward an appropriate cause of treatment.

Lymphangitis is a symptom that may also occur, which is blistering of the site of infection.  Mostly unilateral rather than bilateral, an individual often reports experiencing flu like symptoms prior to a visible presentation. In severe cases it can be life threatening requiring intravenous antibiotics.

Skin Breakdown

Cuts and grazes left untreated has the potential to increase fluid build-up and increase risk of lymphoedema. Effective skin care therefore,  is an essential element of lymphoedema management and requires a full assessment.

Wet Leg Pathway

‘Wet legs’ or Lymphorrhoea is a condition associated with lymphoedema, so called as accumulating lymph seeps through the skin and the patient will require a medical review to ascertain the cause of the issue. The Lymphoedema Network in Wales have created a pathway to follow for the management of this condition.

Lipoedema, not to be confused with lymphoedema, is a condition associated with a plethora of symptoms that can have a negative impact on patients’ lives. Rarely understood, this condition affects primarily women and because of this lack of understanding, many women never obtain a diagnosis. A sad indictment perhaps, but there are many things that we as registered nurses can do, which we’ll explore in the next blog.

Lindsey Lister (Lead Author)

Catherine Best QN

Water in the legs – swollen legs. What helps?

Water retention in the legs

Visible and touchable fluid accumulations under the skin are known as oedemas. If you suffer from heavy legs with swollen ankles there can be various reasons for this.

Water in the legs: Risk factors and causes

The reasons for a patient suffering from swollen legs should always be clarified by a doctor. The most frequent cause of fluid in the legs is a vein weakness. But organ problems or metabolic disorders can also cause swollen legs:

Venous oedema

One possible cause could be venous disease. Particularly if the patient does not exercise enough, the venous valves do not close properly any more, the blood is not entirely transported towards the heart any more and the pressure in the veins in the legs increases. Then fluid is released from the smallest blood vessels, the capillaries, into the tissue. This “water in the legs” is a venous oedema (phleboedema). The swelling usually begins in the ankles because the pressure is highest there, owing to the large volume of blood in the leg veins.

Swollen legs

can also be a symptom of heart failure. If the heart no longer pumps correctly, because of a heart muscle weakness for example, the pressure in the leg veins is increased owing to the blood volume that has not been transported further.

Lymphoedema

With lymphoedema, the leg swelling usually occurs on one side. This indicates that the lymphatic vessel system is not working correctly.

Metabolic disorders

Disorders in the balances of protein, fluid and minerals also influence the exchange of fluids in the body. People who have a kidney, liver or thyroid disorder often have problems with swollen legs.

Further possible causes could be tumours, allergies, medicines, hormone disorders or fluctuations. Therefore, if you suffer from swollen legs you should consult a doctor to establish the cause. The doctor can then suggest the treatment measures that would be appropriate.

Diagram of the calf muscle pump (left: resting; right: during movement)

Why do weak veins cause swollen legs?

The calf muscle pump of a person who is sitting or standing person does not work sufficiently. Blood collects in the veins and there is a continous increase of pressure (venous hypertension). This can lead to increased transfer of fluid from the blood vessel system into the tissue of the leg, where this shows as swelling.  

What helps with water retention in the legs?

Basic therapy: Medical compression stockings

The basic therapy for venous disorders is wearing medical compression stockings. Many studies show that a venous oedema can be treated very effectively with medical compression stockings.1 The swelling is significantly reduced by wearing them.

They are particularly effective in combination with exercise: The muscle pumps are activated and the venous valves close better, meaning that blood is transported to the heart more effectively. Medical compression stockings alleviate the symptoms (sensation of heaviness, tightness, pain, swelling) of chronic venous disease and increase quality of life. Find out more about vein therapy here.

Which doctors treat water retention in the legs?

In order to ascertain the cause of swelling in the legs, the GP first asks the patient about their medical history (anamnesis) including the symptoms and possible known comorbidities.

The doctor can then also assess the condition of the tissue by inspecting it and feeling it and identify possible swelling. kann der Arzt über eine Sicht- und Tastuntersuchung (Inspektion und Palpation) den Gewebezustand beurteilen und mögliche Schwellungen erkennen.

A vein specialist (phlebologist) is able to visualise the blood flow in the veins using a painless ultrasound examination (doppler sonography, duplex sonography). This will establish whether the cause of the problem is the surface veins or the deep vein leg system.

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Source

¹ Rabe E et al. Indications for medical compression stockings in venous and lymphatic disorders: An evidence-based consensus statement. Phlebology 2018;33(3):163-184. 

Your doctor makes the diagnosis and decides on the therapy. If necessary, your doctor can prescribe wound therapy products. The patient is advised by trained personnel (e.g. in a medical supply store, pharmacy, wound centre). After this, the patient receives products that are customised to meet their individual needs.

Why does the skin on the palms and feet wrinkle in hot water

Health

March 8

This is a normal reaction of the body, but only if the effect disappears quickly.

How and why the skin wrinkles

The appearance of wrinkles on the skin in water, regardless of its temperature, modern researchers associate with the work of the sympathetic nervous system. It is activated by a surge of adrenaline and helps the body adapt to emergency situations. In particular, to actions under water or on a damp surface. When wet, the nerve endings transmit a signal to the blood vessels to narrow: the volume of blood in the soft tissues decreases, and the skin shrinks, forming wrinkles.

Now such a reaction of the body seems unnecessary, but it could be really useful for ancient people. Scientists have two versions of its appearance.

1. Wrinkled leather for better wet grip . For example, she could help our ancestors to fish with their bare hands or walk on the ground that was wet after rain without falling. Now this feature can also come in handy, for example, so as not to slip when leaving the shower. However, not all research confirms that wrinkled feet and hands actually work that way.
2. Textured leather drains faster . Wrinkles create channels on the palms and feet that unite the drops into a single stream. This way, the protruding parts become dry and ready to work faster.

Perhaps this effect occurs only on the feet and hands due to the peculiarities of the physiology. There are no sebaceous glands, which means that sebum (sebum) is not produced, one of the tasks of which is protection from moisture. Therefore, the reaction of the nervous system occurs faster.

Alternative version

Previously, the appearance of wrinkles in water was associated with osmosis, that is, the penetration of water through the skin. This version was supported by the behavior of keratin, one of the proteins in the composition of skin cells. Upon contact with water, it gradually absorbs moisture and changes its shape. When dry, the fibers resemble spirals, and when wet, they gradually straighten out and require more space. Keratin is found in the epidermis, that is, in the outer layer of the skin. It expands, and other layers of the skin retain the same volume – that’s why the relief appears. Since the epidermis is thicker on the palms and feet than on other parts of the body, the wrinkling effect is more noticeable there.

However, this theory is refuted by experiments with nerve endings: if they are damaged, the skin of the palms remains smooth even after a long stay in the water. If the cause of wrinkles was in osmosis, the nerve endings would not affect the result.

When to Worry

On average, the skin on the hands and feet should return to normal 10-15 minutes after contact with water. If the smoothing process is delayed, this may indicate aquagenic keratoderma (aquagenic dermatosis). This is a very rare skin condition that occurs in people with cystic fibrosis or in people who carry the cystic fibrosis gene. It can also be caused by a salt imbalance in the skin cells or a reaction to certain medications. Wrinkles in aquagenic keratoderma can persist for an hour or even longer. Sometimes the symptoms are accompanied by small white or colorless rashes on the palms.

If the skin does not shrink at all, this is also a bad signal. He can talk about disorders in the work of the nervous system.

What else happens to the skin in hot water

The hands and feet do not suffer from hot water, unlike other parts of the body. The fact is that, together with sweat and dirt, it washes away part of the sebum – it makes the skin dry and dehydrated, and reduces its protective properties. Therefore, it is better to refuse a piping hot shower or bath. Instead, wash in warm water and, if necessary, apply a moisturizer.

People with eczema, psoriasis, rosacea and other skin diseases are especially advised not to get involved in hot showers or baths. High water temperatures can cause exacerbations.

However, hot water has several advantages. It can relax muscles after exercise and help you fall asleep faster. Sometimes, to achieve relaxation, you can take such a shower or bath, the main thing is not to spend more than 5 minutes in them.

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• How to care for facial skin during pregnancy
• Why the skin on the face is peeling and what to do about it
• Rules for radiant skin: how to care for the face in 20, 30, 40 and 50 years

Smelly hot water is dangerous for the skin: doctors commented on the complaints of Yekaterinburg residents – December 15, 2014

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E1. RU journalists continue to investigate why hot water stinks in Yekaterinburg and its environs. Every day, readers send dozens of letters to the editor about poor water quality. People describe their feelings after taking a shower and washing dishes, and some say that water has a bad effect on their health: people complain of rashes, allergies, peeling of the skin.

“The water started smelling about a month ago. It’s just not possible to wash, the water stinks terribly. When I went to the shower in another apartment, where there was normal water, I could see how the dirt was draining from my body because of the past water. I already I keep quiet about brushing my teeth, it’s generally impossible and disgusting. Also, because of this water, a rash appears, “Kristina from Yekaterinburg, who lives opposite Antey, shared with E1.RU.

Nikolay from the house at Otto Schmidt, 48a, told journalists that his wife and two-year-old child had “an insane allergy to such water.”

“The smell of the water is terrible, and after washing with such water, the skin becomes oily! In a few months, the skin and hair from such water have noticeably deteriorated,” Elena told E1. RU.

Yekaterina from the house at 14, Rodonitovaya Street, noted that the water has smelled awful since the beginning of the heating season, and the skin reacts strangely to contact with this liquid.

“Impossible to wash in the bathroom, my hands are always dry, and the child’s hands began to turn red and peel off. It’s impossible. The smell is like there is a garbage dump nearby. How long will it last!!! And you pay for normal hot water,” she shared from E1.RU Ekaterina.

Medical experts confirmed to E1.RU that Yekaterinburg residents may have skin problems due to poor hot water. Dermatovenereologists note the traditional increase in calls from people after turning on the heating in their homes. Dirty foul-smelling hot water that comes from taps has a negative effect on the protective integument of the skin.

– A negative factor is present. For comparison: either the purest artesian water, in which there are no impurities, or water that changes the protective lipid barrier. This water causes dryness, peeling, short-term redness, – Igor Kuklin, a candidate of medical sciences, a doctor of the highest medical category, a senior researcher at the Ural Research Institute of Dermatovenereology and Immunopathology, told E1.RU. – Protective lipid barrier forms resistance to many inflammatory diseases and bacterial infections. An increase in visits to doctors at the beginning of the heating season arises because our water is far from European indicators.

Let us remind you that the experts said that the water that comes from the “red” taps cannot be used, as it passes through the heating system. People are supplied with technical water with additives that even spoil metal, according to public utilities. In the Sverdlovsk heat supply company, on the contrary, they assure that hot water is of the same quality as cold water. A few days after the release of the publications, the Sverdlovsk Rospotrebnadzor announced that it had launched an investigation into resource suppliers.