If the client suffers from edema – both lymphedema and venous edema – good skin care is extra important. Karen Keus-Jansen, specialist in edema and oncology physiotherapy, gives tips.
How do you know if the client suffers from edema?
Edema can develop anywhere in our body. In the case of limbs, people often complain about heavy, tight or tired legs and or arms, sometimes painful and restless legs. Or they feel like they are walking on cotton wool, which can also indicate neuropathy. When we look at the legs or arms, we can tell by the skin. Depending on the duration and stage of the edema, the skin is taut, dry, sometimes shiny, with a brownish discoloration of the skin and swelling is usually visible.’
How can you check if someone has edema?
‘To do rapid tests we can try to shift the skin or grab a skin fold, this is called Godet’s test. Or press the fingers firmly into the skin for a minute (Stemmer’s test). Depending on the phase of edema, the fingers remain standing, this is also referred to as pitting edema. We also always do a volume measurement.’
What causes edema?
‘Edema is usually caused by surgery, heart-renal problems, venous, arterial, or lymphatic problems, infection, and by medication.’
What happens if you do nothing about edema?
‘It’s a progressive condition, doing nothing is not an option. Edema gives a number of complaints, such as tight clothing and footwear, jewelry that pinches, disturbed sensory perceptions (sensory) such as touch, pain, pressure, hot, cold, sharp, reduced self-confidence, social isolation, inactivity, restriction of movement, weight gain, skin problems, wounds, infections, impaired immune system, sepsis, organ failure and, in extreme cases, death.’
What effect does this have on the skin?
‘The skin is our largest organ and also a fragile organ. In addition to our lymphatic system, it has a very important function in our immune system, it protects us from the outside against bacteria and viruses, also known as the skin barrier. The skin has an average pH value of around 5.5. The (epider) skin is nourished by a good balance of moisture, which is supported by lymphatic vessels and blood vessels and neurotransmitters / sensors in the skin. If this balance is disturbed, an imbalance arises, the pH value changes and harmful bacteria can start to grow.’
What can upset the balance?
‘For example edema, wearing tight clothing, for example therapeutically elastic stockings (TEK), the cold weather, heat, using a lot of water, using the wrong soap or cream, hormones, nutrition, wounds, bumps, scratching and the use of medicines. Small skin defects such as dryness then arise, which can be recognized by the small skin flakes, which can eventually turn into heavy flakes and cracks in the skin, wounds on the skin, skin changes such as color and structure. This means that bacteria and viruses can more easily enter the body through the skin. As a result, people can get the flu or skin infections.’
What is the most common skin infection?
Erysipelas (Erysipelas) is a more common infection in people with edema and therefore poses an additional risk. It’s a streptococcus where doing nothing damages skin, lymphatic vessels – it causes even more edema and blood vessels. It can eventually enter the bloodstream, which if left unchecked will ultimately result in death. This almost always requires oral or intravenous antibiotics.’
How do you recognize dandruff?
‘Wandrose can be recognized by a red spot that spreads quickly. Sometimes blisters can form. Furthermore, it is often accompanied by an increase in edema, the client does not feel very fit and this can turn into a fever. Once erysipelas has had, the chance of returning is high. If erysipelas is controlled with antibiotics, edema often remains. This is a breeding ground for bacteria such as streptococcus. That is why getting edema under control is extra important to keep the chance of recurrence as low as possible. Because when it returns it causes more and more damage to surrounding tissue such as lymphatic vessels, blood vessels and the immune system.’
What can you do about edema?
‘In case of edema, ask for immediate help from an expert, such as a general practitioner, wound care nurse or edema physiotherapist. Draw up a treatment plan together. Determine the cause of edema, if possible after a good ankle arm index – or in case of diabetes a toe pressure measurement – and rule out contraindications for bandaging. Subsequently, TEK are usually measured by a general practitioner.’
How do you keep the skin fit?
‘You tackle skin problems by, among other things, observing good skin hygiene. Such as rubbing the skin with a cream. For this I recommend a PH 5, because bad bacteria don’t like that. This reduces the risk of infections. Consult with an expert which cream to use and how often to apply.’
How do you involve the client in this?
‘It is often difficult to provide good care for existing problems during the client’s time. Nevertheless, we can involve clients by providing good information about good skin care and hygiene. It is important to keep the skin barrier in balance as much as possible: do not shower for too long, do not use too much and a neutral soap, in case of edema, do not wear tight clothing, jewellery, footwear – pinching can cause even more edema – skin problems and wounds, do not sit in direct sunlight and rub the skin with sun factor 50. And in case of dry skin, apply the right cream.’
What if the client is wearing TEK?
‘Then I recommend applying it in the evening. Manufacturers cannot give a product guarantee if you apply the cream to the skin just before putting on the TEK cream. This can damage the TEK and can also leave behind bacteria faster due to the fat that remains in the TEK. If, on the advice of the practitioner, the skin needs to be rubbed in twice or more a day, it is recommended to apply the cream half an hour to an hour before putting on the TEK.’