Lymphoedema Evidence Library › Topics › Wounds, skin and cellulitis
Wounds, skin and cellulitis
Wounds, skin and cellulitis
21 sources
Evidence in one minute
- Skin care is fundamental to every lymphoedema programme (cleansing, low-pH emollients, inspection, fungal treatment); both conservative and surgical treatment reduce cellulitis. Executive Committee of the International Society of Lymphology 2023
- Cellulitis: antibiotics for true infection (fever, pain, spreading erythema); prophylactic penicillin if recurrent despite optimal CDT. Lymphatic microsurgery reduces cellulitis frequency (low certainty — uncontrolled series; revised 2026-10-08). Executive Committee of the International Society of Lymphology 2023 · Gloviczki 2026
- Wounds in lymphoedematous legs: treat the oedema, not just the wound — compression (bandage/garment chosen by limb shape) plus exudate-appropriate dressings; ABPI with clinical judgement. Keast 2025 · Wounds 2014 · Davey 2014
- Hyperkeratosis: washing, emollients, keratolytics, mechanical debridement. All Wales Tissue Viability Nurse Forum 2014
- Lymphoedematous limbs are not hypoxic on TcPO2 (arm data) — look for arterial disease if TcPO2 is low. Mayrovitz 2005
- Massive localised lymphoedema mimics sarcoma. Fife 2014
- Chronic venous disease and lymphoedema overlap (phlebolymphoedema); ICG shows lymphatic dysfunction in venous ulcers (Rasmussen 2016, via Vivian 2019).
- WAWLC principle: control peri-wound oedema/lymphoedema. World Alliance for Wound and Lymphoedema Care 2009
Update 2026-10-08 — downloaded evidence
- Recurrent cellulitis: penicillin V 250 mg twice daily for 12 months halves recurrence while taken (22% vs 37%, NNT 5); effect stops when stopped; leg lymphoedema, BMI ≥33 and multiple prior episodes predicted a poorer response — treat the oedema as well (PATCH I — double-blind, low risk of bias: high certainty for recurrent cellulitis, moderate in lymphoedema; PATCH II after mostly first episodes inconclusive, low). Thomas 2013 · UK Dermatology Clinical Trials Network’s PATCH Trial Team 2012
- Hygiene cuts filarial acute attacks by ~two-thirds. Stocks 2015
- Stewart–Treves angiosarcoma mimics bullous erysipelas — biopsy atypical purple papules. da Costa Vieira RA 2019
Appraisal update 2026-10-09
- Do not follow the Alavi/Sibbald chapter on drugs: it calls warfarin “coumarin, a benzophenone”, describes benzopyrones as low-toxicity (coumarin was withdrawn for hepatotoxicity) and advises doxycycline/trimethoprim/erythromycin prophylaxis instead of penicillin V. Its skin-care and compression-by-ABPI sections are usable. Alavi unknown
- Biopsy the non-healing lymphoedematous ulcer: a basal cell carcinoma was treated with dressings for 3 months (patient account); Stewart–Treves and Kaposi sarcoma (HIV, Durban case) are the other malignancies to exclude. Hasznosy 2012 · Ebrahim 2009 · da Costa Vieira RA 2019
- Industry pathway sheets (Wounds UK 2014 with BSN, 2022 with medi) are brand-led and unreferenced — use their structure, not their product choices. Single cases (van Zanten 2013, Vivian 2019) show what inelastic compression does to ulcers and oedema but have no comparator. Wounds 2014 · Wounds 2022 · van Zanten M 2013
Gaps
No trials of wound outcomes with vs without lymphoedema treatment are held; Stewart–Treves now covered (da Costa Vieira 2019).
How the evidence points
| High | Mod. | Low | V. low | None | |
|---|---|---|---|---|---|
| Positive | 1 | 0 | 1 | 0 | 0 |
| Null or negative | 0 | 0 | 1 | 0 | 0 |
Sources on this page with a comparison, by the result of their primary outcome and the GRADE certainty of their main finding (Mod. = Moderate, V. low = Very low, None = not graded). Context sources are not counted. How direction is decided.
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