Complications
Anxiety and depression are common in people with lymphoedema.[86] Patients may experience distress associated with poorly fitting clothing and concerns about their physical appearance, and functional impairment. Frequency of infection, pain, poor skin quality, and reduced limb function predict their quality of life.[86]
Lymphoedema is not commonly recognised in many healthcare settings and therefore patients may feel abandoned. However, increased awareness of lymphoedema by the healthcare community and support groups has improved the psychosocial well-being of these patients. Ongoing assessment of health-related quality of life and patient’s perceptions of symptoms and functioning using validated disease-specific tools is recommended.[47] Examples include the Lymph-ICF-Lower Limb (Lymph-ICF-LL) and Lymphoedema Quality of Life Inventory (LyQLI).[123][124]
People with lymphoedema have an increased risk of developing recurrent soft-tissue infection, such as cellulitis (affecting the deep layers of the skin) or erysipelas (affecting the superficial layers).[125] Cellulitis frequently affects patients with lymphoedema; they have a 71 times increased risk of infection in the affected area.[3][18] Twenty-nine percent of patients will have at least 1 infection annually; 1 in 4 will require admission to hospital.[18]
Patients should avoid even minor trauma to the affected area. If infection is suspected, oral antibiotics should be given promptly, and a low threshold should exist for admission to hospital and intravenous antibiotics. It is widely assumed that recurrent episodes of cellulitis damage the cutaneous lymphatics resulting in worsening of lymphoedema, although this is difficult to establish based on the available evidence.[1] People with recurrent cellulitis or erysipelas (e.g., ≥3 episodes per year) may benefit from chronic prophylactic oral antibiotic therapy.[126][127]
Lymphangitis (inflammation of the lymphatic system) and fungal skin infections are also a concern. Preventive measures include good skin hygiene and wearing protective clothing. Fungal infection is treated with antifungal drugs.[47]
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