Cellulitis in the Presence of Lymphedema?

Last Modified: August 13, 2006

Dear OncoLink "Ask The Experts,"
After having right axillary lymph node dissection (ALND) and radiation concluding in January for local recurrent melanoma, I developed lymphedema and what they believe is cellulitis.

It took me probably 2-3 weeks to finally get my arm evaluated. I'm seeing a lymphedema therapist now and I've been bandaging my arm for the last 2 weeks while taking high doses of Bactrim for 10 Days.

My arm is still swollen, red, and blotchy in some areas, but the swelling is much better than when I first walked into the clinic.

Linda McGrath Boyle, PT, DPT, CLT-LANA, Cancer Rehab Specialist and OncoLink Lymphedema Team Editor, responds:

Cellulitis is an infection of the skin and underlying tissues. It is very common in persons with lymphedema due to a sluggish lymphatic system in the area of the swelling. The lymphedema itself creates a barrier to removal of fluid, bacteria, and cellular waste. The infection can progress quickly, before the impaired lymphatic system is able to respond. This abnormal response only occurs in the part of the body with lymphedema.

Bacteria can enter the body through a very small break in the skin, so meticulous skin and nail care is important. People with lymphedema should be taught precautions in an effort to avoid progression of lymphedema to the next stage. Lymphedema therapists also educate persons who are at risk for developing lymphedema. Precautions include being cautious to avoid any cuts, burns or injury to the affected limb (do not cut cuticles or bite nails, avoid needle sticks, use a bug spray to avoid insect bites if outside in the warm months and just practice general caution!). They should avoid anything restrictive to the limb, including blood pressure cuffs and restrictive clothing or jewelry.

The symptoms of cellulitis include:

Erythema (red skin)
The area becomes warm/hot.
Local pain may be present.
Fever of 100.5 degrees F or greater.
Increased swelling in the area.

Early treatment is extremely important to prevent the infection from progressing. Persons with lymphedema must be given antibiotics as soon as possible in order to prevent the spread of infection. If you are unable to contact your health care team immediately and be treated within a few hours, it is best to go to the emergency room. Be sure to let the physician know that you have lymphedema and require immediate attention.

Other infections that commonly occur in persons with lymphedema include lymphangitis (an inflammation of one or more lymph vessels) and fungal infections such as athlete's foot.

The American Cancer Society published an excellent patient focused book in 2006 entitled Lymphedema: Understanding and Managing Lymphedema After Cancer Treatment. For more information, contact the American Cancer Society at 800-ACS-2345 or http://www.cancer.org.