Skin and Wound Care in Lymphedema Patients: A Taxonomy, Primer, and Literature Review

Caroline E. Fife; Wade Farrow; Adelaide A. Hebert; Nathan C. Armer; Bob R. Stewart; Janice N. Cormier; and Jane M. Armer, Advances In Skin & Wound Care & Vol. 30 No. 7.

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Skin and Wound Care in Lymphedema Patients: A Taxonomy, Primer, and Literature Review.

Caroline E. Fife; Wade Farrow; Adelaide A. Hebert; Nathan C. Armer; Bob R. Stewart; Janice N. Cormier; and Jane M. Armer, Advances In Skin & Wound Care & Vol. 30 No. 7.

Abstract

BACKGROUND:

Lymphedema is a condition of localized protein-rich swelling from damaged or malfunctioning lymphatics. Because the immune system is compromised, there is a high risk of infection. Infection in patients with lymphedema may present in a variety of ways.

OBJECTIVE:

The goals of this review were to standardize the terminology of skin breakdown in the context of lymphedema, synthesize the available information to create best practice recommendations in support of the American Lymphedema Framework Project update to its Best Practices document, and create recommendations for further research.

DATA SOURCES:

Publications on skin care and wounds were retrieved, summarized, and evaluated by a team of investigators and clinical experts.

STUDY SELECTION AND DATA EXTRACTION:

Terms for lymphedema-associated skin breakdown were compiled and paired with photographs of commonly noted skin changes among patients with lymphedema. A list of standard dermatological terms was created. A more extensive literature search was then conducted by all authors.

DATA SYNTHESIS:

Skin disorders associated with lymphedema have been classified into 5 categories. Descriptions, photographs, and recommendations for treatment are presented.

CONCLUSIONS:

Skin care is an important defence against infection. Because of the lack of research, a consensus of thought and content leaders’ opinion should guide the best practices for wound care in lymphedema

Main findings

This article provides an excellent rubric for lymphoedema skin disorders including a description for each. It also includes photos for each of the skin conditions.

Skin conditions are divided into:

Skin disorders directly caused by lymphedema:

  • Lymphedema rubra,
  • Skin fissures,
  • Dermal lichenification,
  • Papillomas and fibromas,
  • “Mossy” lesions (eg.”mossy foot” extensive fine papillomatosis often with associated lymphorrhea),
  • “Frogs spawn” (multiple larger papillomas that develop due to chronic lymphedema),
  • Dermal fibrosis,
  • Nodular fibrosis,
  • Lymphangiectasia/lymphangioma ,
  • Lymphorrhea/lymphocutaneous fistula,
  • Elephantiasis verrucosa nostra,
  • Massive localized lymphedema,

Skin disorders indirectly related to lymphedema/obesity:

  • Folliculitis, lymphangitis,
  • Cellulitis,
  • Dermatitis and eczema,
  • Lichen simplex chronicus,
  • Fungal infections,
  • Pressure injuries,
  • Limb enlargement and distortion.

Skin disorders associated with diseases causing lymphedema:

  • Nonhealing surgical wounds,
  • Irradiated wounds,
  • Malignant wounds,
  • Traumatic wounds,
  • Venous stasis ulcers and phlebolymphedema,
  • Lipodermatosclerosis and stocking erythroderma.

Skin disorders in mixed venous and lymphatic disease:

  • Chronic panniculitis,
  • Fibrosis of the dermal and epifascial tissues,
  • Acute and chronic lipodermatosclerosis.