Infection and lymphoedema

Symptoms of infection

There are several symptoms you might have when you have an infection.  A fever may be the first or only sign of an infection. But with some infections, you may have other symptoms without a fever.

Call your 24 hour advice line straight away if you have any of these:

• a change in your temperature – 37.5°C or higher or below 36°C

• flu-like symptoms – feeling cold and shivery, headaches, and aching muscles

• generally feeling unwell

• reddening of the skin – this might start in one area and get larger, include the whole limb or cause red lines

• swelling

• warmth or heat around the affected area

• pain

• being sick (vomiting)

• feeling dizzy or faint

• a fast heartbeat

Cellulitis

People with lymphoedema are at risk of developing an infection called cellulitis. Or an acute inflammatory episode (AIE).

Cellulitis is an infection of the deep layers of the skin. This type of infection can cause damage to the lymphatic vessels. You can become very unwell with cellulitis and will need antibiotic treatment.

Remember early treatment helps to stop an infection becoming more serious and can stop your lymphoedema from getting worse. So the most important thing you can do is contact your 24 hour advice line straight away. 

If you have symptoms of an infection, don’t wear your compression garments until you've started treatment for the infection. Or your specialist says you can wear them again.

Tips to help lower your risk of infection and injury

These tips can help to reduce your risk of infection or injury:

• Protect your hands from cuts and scratches when you’re doing household jobs such as washing up, gardening or DIY.

• With arm lymphoedema, wear oven gloves and long sleeves to avoid burns when getting things in and out of the oven.

• Wash and dry your feet thoroughly, including between your toes - if you have had fungal infections before, you might need to use athlete’s foot powder to prevent another one.

• Be careful to avoid scratches when handling pets - clean the area straight away if they scratch you.

• Be careful when removing body hair. Using an electric razor may help avoid injuring the skin. Hair removal creams can irritate the skin and you need to check you are not allergic to the cream. Before using any hair removal products ask your lymphoedema specialist for advice.

• Wear well fitting shoes and avoid going barefoot if you have lymphoedema of the leg - this lowers your risk of blisters or injuring your feet.

• Be careful when cutting your nails, and use nail clippers - if it’s difficult to cut your toenails, see a chiropodist regularly.

• Look out for any thickening of the skin, changes in colour, and any blisters or spots - contact your lymphoedema specialist if you have these.

• Be careful if you use hot tubs or saunas and use them for a short amount of time. There is some evidence the heat might affect the swelling. But more research is needed. Always check the swollen area for any changes while you use a hot tub, saunas, and steam rooms. To reduce the risk of infection avoid these if you have any open wounds or cuts in your skin.

Treating infection

Your doctor will prescribe antibiotics. You might need to have them into your bloodstream (intravenously) at first. Once the infection is under control, you can take them as tablets or capsules. It is important that you take the full course of your antibiotics. 

The most commonly used antibiotics are flucloxacillin or amoxicillin. Your doctor may prescribe erythromycin or clarithromycin if you are allergic to penicillin. 

You might need to take a low dose of antibiotics each day if you have several infections within a short time. This is to prevent further infections. You may need to take them for up to 2 years.

The British Lymphology Society (BLS) has a consensus document that gives advice to doctors. It guides them on the use of antibiotics for people with lymphoedema. You can take this with you to your doctor. 

Find out about the consensus document

Leaking fluid

Sometimes lymph fluid can leak from the surface of the skin. This is called lymphorrhoea (pronounced lim-for-ree-a). The fluid is straw coloured.

It can happen if you scratch the skin when it is swollen. It can also happen if you hurt the area when the skin has become scaly. Sometimes lymphorrhoea occurs when the area has become swollen quickly.