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Prevention of Cellulitis

Now you have been diagnosed with lymphedema. It doesn't matter whether it is primary or secondary, your next big battle is going to be dealing with infections (more commonly called cellulitis or lymphangitis).

It is true that no matter what you do, sometimes, these infections come out of no where. One day you are fine and the next day you are in the hospital.

Learn to listen to your body. If you start getting that "flu-like" achiness, running a low grade fever or have any unusual redness in the lymphedema limb, pay attention. Getting on antibiotics early can spare you from that hospital visit.

Also, one very important rule of thumb is to always keep a supply of antibiotics on hand. When cellulitis attacks, you do not need to waste time waiting for the doctor to call in the prescription or waiting for the pharmacy to fill it. Prompt treatment is urgent.

But there are certain things that we can do that will lessen our chances of getting these nasty infections.

Here are a few tips I have picked up along the way. They may seem redundant, but every little thing we can do is going to help us.

Remember, the best treatment is preventative treatment.  Every time we get cellulitis, there is scarring of the lymphatics and as a result a worsening of our lymphedema.  There are also serious complications that can also arise from the infection itself, these include:

Sepsis (Septicemia) (Septic shock) - Bacteremia - Gangrene - Meningitis


Preventative Antibiotic Therapy

If you are particularly susceptible to infections, you may wish to discuss with your doctor about undertaking preventative antibiotic therapy.

There are a couple ways of doing this.

Either an oral antibiotic (I take 2 875mg augmentins every day.)
Or if you are not allergic to penicillin, you may well consider taking long acting penicillin injections. This worked wonderfully for me during the 1970's. Until my family allergy to penicillin raised its ugly head, this was perhaps the most successful therapy I have had in preventing cellulitis.

Remember one important point regarding cellulitis. With fibrosis
the bacteria is able to "hide" in pockets and may escape the antibiotic or the fibrosis will make it much more difficult for the
antibiotic to be effective. Doing all you can to prevent infections is critical.

For those of us with lymphedema, who are also exceptionally susceptible to cellulitis, I strongly recommend being under the care of an infectious disease doctor.



Another important step in preventing cellulitis is in understand the concept of what is called Septic Foci. This is the concept that certain body areas are focal points of infection. These are locations within us that bacteria easily grow, and eventually spread throughout our system.

The principle area of such focus is the bowel, followed by teeth, gums, sinuses, throat, ulcers and any other areas wherein pockets of toxins and bacteria multiply.

Another major area would be dermal inflammations. Examples of this would be carbuncles, boils, impetigo acne and other superficial abscess. Other areas that could become a host site (entry foci) would be wounds, cracks, scratches and fungal infections of the skin. That is why it is so absolutely important that we do all we can in preventing and/or treating these conditions with the appropriate medical care.

I would especially like to express my thanks and appreciation to Prof. S. Jamal, Retired Professor of Plastic Surgery, and member of the Lymphology Society of India for suggesting a note on this topic.



A word of caution also as regards our family pets. We love them and they are an important part of our family, but we can also get infections from them.  Many, many cats carry a bacteria called Bartonella henselae which causes cat scratch fever

What is cat scratch fever?

It is a bacterial disease caused by Bartonella henselae. Most people with CSD have been bitten or scratched by a cat and developed a mild infection at the point of injury. Lymph nodes, especially those around the head, neck, and upper limbs, become swollen. Additionally, a person with CSD may experience fever, headache, fatigue, and a poor appetite. Rare complications of B. henselae infection are bacillary angiomatosis and Parinaud's oculolandular syndrome.

It is contracted from either a scratch or bite, so please, be careful when playing with kitty.  It is interesting that one of the oldest archived articles I ran across in PubMed was on secondary lymphedema as a result of cat scratch fever.


Hot Tubs

Hot tubs also present a problem for those of us with lymphedema.  I again urge caution in using hot tubs.  Infact, ifyou are especially susceptible to infections as I am, you probably want to consider not ever using one.  There is a common form of folliculitis that you can get from them.

This is a superficial skin infection usually caused by Pseudomonas aeruginosa. Pseudomonas survives in hot tubs, especially hot tubs made of wood, unless the water's acid and chlorine levels are strictly controlled.

Symptoms include: 

Treatment includes antibiotics, and anti-itch medications.  However, since this is a "gram-negative" infections it can be quite difficult to eradicate.


Simple self-care techniques

Handwashing: Hand washing is the most important thing you can do to prevent infection. You should wash your hands several times every day. Soap and water cannot kill germs but they loosen the normal skin oil where germs live. Always wash your hands after you have been to the bathroom. You should also wash your hands every time you cough, sneeze, or blow your nose. Wash your hands before and after giving patient care to a family member. Always wash your hands before you prepare or eat food.


Bathing: Shower often. Make sure to wash between folds of your skin. You should bathe/shower every day to keep your body clean and to keep from getting an infection. If you work in a public place, outside, or with food or animals, you should bathe often. If you live in a warm humid climate - I would even recommend two showers a day.

Also, my rule of thumb is never use a towel, wash cloth twice. The little extra laundry is well worth the effort. Bacteria can build up quickly in a damp cloth.

Wash your hair regularly.

It is also very important to wash thoroughly the feet, between the toes, the groin area. These are prime bacteria breeding grounds.

Trim your finger and toenails once a week. Doing this after a bath or shower is often easier because the nail is softer. Tell your caregiver if you cannot see or reach your nails to trim them.

I also advise against going to "nail" salons. The has been an epidemic of nail infections from unsanitary tools.


Dental Care: Each family member should use his own toothbrush and drinking glass.

Infections in your mouth can be caused by food left on or between your teeth. Brush your teeth at least 2 times each day. It is best to do this in the morning and before bed. Gargle with mouthwash if you cannot brush after a meal.

Floss your teeth each time you brush. This helps to remove food from between your teeth.

Change the water in your denture cup every day if you have dentures.

It is very important to see your dentist at least once a year. Dental caregivers can give your teeth a deeper cleaning than you can. This prevents cavities and infections in your mouth.

If you have dental problems, take care of them as quickly as possible. Mouth infections can spread rapidly - even to the point of causing septicemia.

Housecleaning: Dust and vacuum your house every week. I know how difficult this can be with the pain and fatigue we experience with lymphedema (some with lymphedema and cancer).

Mop the kitchen and bathroom floor each week and when something is spilled. This includes all the nooks and crannies.

Wash trash containers with soap and water. Then spray the container with a disinfectant. Always use plastic garbage bags to help keep these clean.

Keep the inside of the refrigerator clean. Use soap and water to clean it about every month. Keep foods that can spoil in the refrigerator. Throw away food that is spoiled.

When using a cutting board, wash it with soap or put it in the dishwasher often. Always wash the cutting board carefully after you have put raw meats on it.

Use a cleaning product to clean the kitchen counter. Many germs can live on a kitchen counter if it is not kept clean. You would be amazed at the number of and types of germs that live on what appears to be a clean counter top.

If you use a sponge in the kitchen replace it every few days. Also, every time that dishwasher is run, throw the sponge in it. Sponges are another favorite breeding ground for bacteria.

Bathrooms absolutely must be kept clean. In the old days there was nothing like Comet, Ajax or Bon Ami cleaner. Now there are many excellent spray products that help make this job much easier.

When you clean, also clean shower heads and faucets too. You may also want to use latex (or alternative if you are allergic to latex) gloves while cleaning your bathroom and/or kitchen.


Clothing: A rule of thumb I use is never wear a piece of clothing twice without washing. It may still look lean, but again
all clothing picks up bacteria. Also, clean sheets are a must! You may wish to change them every few days.

Shoes I use regularly an anti-fungal powder in my shoes. Not only does it help keep them smelling fresh but provides an extra added bit of protection from potentially catastrophic fungal infections.


Gardening and outdoor work: Always, always wear gloves when you are working outside. I love gardening and seeing my yard explode with flowers in the Spring and Summer. When I plant those little seedlings, I trade my regular gloves for latex gloves. Its easier to handle the little plants in those. Never ever dig around in the soil with your bare hands. (I have learned the hard way about this.)


Traveling: I always carry my bottle of disinfectant when traveling. I will not use a bathroom in a motel until I have disinfected it. You may also wish to carry your own set of sheets.


Skincare: It is absolutely imperative that you maintain excellent skin care. Any scratch, wound or rash must be dealt with immediately. Those of us with extensive stage 2 or 3 lymphedema have a double duty as our skin will get so dry and try to crack.

Use skin moistening creams and lotions to help with this.

Those wounds we all get that leak lymphorrea? Take care of them
immediately. Not only does the lymphorrea severely damage surrounding skin tissue, but the wound provides a welcome mat to bacterial infections.

Outdoors: Always when outdoors, use an insect repellant. A simple mosquito bite or flea bite can quickly send us to the hospital


Lakes, swimming pools, hot tubs: A very good rule of thumb is to stay away from these. Especially ones that are used by a number of people. The chlorine used in these does NOT always kill bacteria.

Nail Care: As mentioned earlier, the best time to trim your nails is after a bath when they are softer. Never allow yourself to get a hang nail. And for women, I strongly urge not using the stick on nails. These also provide a safe haven for bacteria.

Remember, we don't have to live in a cocoon. Nor do we have to live every minute in fear of a germ. But there are some very simple guidelines that will help keep us healthier and keep us out of the hospital.


Alcohol:  Consumption of alcohol should be limited with people having lymphedema.  Your body can not metabolize alcohol and converts it into sugar.  The sugar level then increases in your body system. It is this sugar that provides "food" for bacteria.


Basic Lifestyle Tips  


Prevention of Cellulitis

eMedicine Health


Prevention of Cellulitis

While is may be actually impossible to totally rpevent the possibility of contracting cellulitis, there are tips to help us prevent and/or avoid it.  Remember, if you have lymphedema, it is imperative to try as best you possibly can to prevent and/or avoid cellulitis.

The Mayo Clinic offers these suggestions:

To help prevent cellulitis and other infections, follow these measures anytime you have a skin wound:

Wash your wound daily with soap and water. Do this gently as part of your normal bathing.

Apply an antibiotic cream or ointment. For most surface wounds, a single- or double-antibiotic ointment provides adequate protection.

Watch for signs of infection. Redness, pain and drainage all signal possible infection and the need for medical evaluation.

People with diabetes and those with poor circulation need to take extra precautions to prevent skin wounds and treat any cuts or cracks in the skin promptly. Good skin-care measures include the following:

Inspect your feet daily. Regularly check your feet for signs of injury so you can catch any infections early.

Moisturize your skin regularly. Lubricating your skin helps prevent cracking and peeling.

Trim your fingernails and toenails carefully. Take care not to injure the surrounding skin.

Protect your hands and feet. Wear appropriate footwear and gloves.

Promptly treat any superficial skin infections, such as athlete's foot. Infections on the surface of the skin (superficial) can easily spread from person to person. Don't wait to start treatment.

Mayo Clinic


How To Clean a Skin Wound 

Proper cleaning and treatment of a superficial wound is a critical step in preventing not only cellulitis, but other possible bacterial infections as well.

Date updated: June 30, 2006
Sydney Youngerman-Cole, RN, BSN, RNC
Content provided by Healthwise

Skin wounds need thorough cleaning to reduce the risk of infection and scarring and to promote healing. Try to stop the bleeding before cleaning the wound. Mild to moderate bleeding during the cleaning usually occurs. After cleaning, stop the bleeding by applying direct pressure again and elevating the wound.

A visit to a health professional is needed if you are unable to clean the wound adequately because it:

Before cleaning the wound Rinse the wound

If you are not going to see your health professional immediately, rinse the wound for at least 5 to 10 minutes:

Large, deep, or very dirty wounds Minor wounds can be cleaned at home

Revolution Health


Prophylactic antibiotics for the prevention of cellulitis (erysipelas) of the leg: results of the U.K. Dermatology Clinical Trials Network's PATCH II trial.

Sept 2011

U.K Dermatology Clinical Trials Network’s PATCH Trial Team.


Centre of Evidence Based Dermatology, University of Nottingham, King's Meadow Campus, Lenton Lane, Nottingham NG7 2N, U.K.


Summary Background  Cellulitis (erysipelas) of the leg is a common, painful infection of the skin and underlying tissue. Repeat episodes are frequent, cause significant morbidity and result in high health service costs. Objectives  To assess whether prophylactic antibiotics prescribed after an episode of cellulitis of the leg can prevent further episodes. Methods  Double-blind, randomized controlled trial including patients recently treated for an episode of leg cellulitis. Recruitment took place in 20 hospitals. Randomization was by computer-generated code, and treatments allocated by post from a central pharmacy. Participants were enrolled for a maximum of 3 years and received their randomized treatment for the first 6 months of this period. Results  Participants (n = 123) were randomized (31% of target due to slow recruitment). The majority (79%) had suffered one episode of cellulitis on entry into the study. The primary outcome of time to recurrence of cellulitis included all randomized participants and was blinded to treatment allocation. The hazard ratio (HR) showed that treatment with penicillin reduced the risk of recurrence by 47% [HR 0·53, 95% confidence interval (CI) 0·26-1·07, P = 0·08]. In the penicillin V group 12/60 (20%) had a repeat episode compared with 21/63 (33%) in the placebo group. This equates to a number needed to treat (NNT) of eight participants in order to prevent one repeat episode of cellulitis [95% CI NNT(harm) 48 to ∞ to NNT(benefit) 3]. We found no difference between the two groups in the number of participants with oedema, ulceration or related adverse events. Conclusions  Although this trial was limited by slow recruitment, and the result failed to achieve statistical significance, it provides the best evidence available to date for the prevention of recurrence of this debilitating condition.

2011 British Association of Dermatologists 2011.


Related Lymphedema People Medical Blogs and Pages:



Antibiotic Glossary

Antibiotic Therapy, Types of Antibiotics

Bacterial Infections



Cat Scratch Fever



Complications of Cellulitis




Infectious Disease Doctor



MRSA Information Blog

Methicillin Resistant Staphylococcus Aureus - MRSA

Necrotizing Fasciitis

Preventing Hospital Infections


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