I. Skin Care - Avoid trauma / injury to reduce infection risk
Keep extremity clean and dry
Apply moisturizer daily to prevent chapping/chafing of skin.
Attention to nail care; do not cut cuticles
Protect exposed skin with sunscreen and insect repellent
Use care with razors to avoid nicks and skin irritation
If possible, avoid punctures such as injections and blood draws
Wear gloves while doing activities that may cause skin injury (e.g. washing dishes, gardening, working with tools, using chemicals such as detergent)
If scratches/punctures to skin occur, wash with soap and water, apply antibiotics, and observe for signs of infection (i.e. redness)
If a rash, itching, redness, pain, increased skin temperature, increased swelling, fever or flu-like symptoms occur, contact your physician immediately for early treatment of possible infection.
II. Activity / Lifestyle
Gradually build up the duration and intensity of any activity or exercise. Review the Exercise Position Paper.
Take frequent rest periods during activity to allow for limb recovery
Monitor the extremity during and after activity for any change in size, shape, tissue, texture, soreness, heaviness or firmness.
Maintain optimal weight. Obesity is known to be a major lymphedema risk factor.
III. Avoid Limb Constriction9
If possible, avoid having blood pressure taken on the at-risk extremity, especially repetitive pumping.
Wear non-constrictive jewelry and clothing
Avoid carrying a heavy bag or purse over the at risk or lymphedematous extremity. .
IV. Compression Garments
Should be well-fitting
Support the at-risk limb with a compression garment for strenuous activity (i.e. weight lifting, prolonged standing, and running) except in patients with open wounds or with poor circulation in the at-risk limb
Patients with lymphedema should consider wearing a well-fitting compression garment for air travel. The NLN cannot specifically recommend compression garments for prophylaxis in at-risk patients.
V. Extremes of Temperature1
Individuals should use common sense and proceed cautiously when using heat therapy. Observe if there is swelling in the at-risk limb or increased swelling in the lymphedematous limb and cease use of heat such as a hot tub or sauna.
Avoid exposure to extreme cold, which can be associated with rebound swelling, or chapping of skin
Avoid prolonged (greater than 15 minutes) exposure to heat, particularly hot tubs and saunas
VI. Additional Practices Specific to Lower Extremity Lymphedema
Avoid prolonged standing, sitting or crossing legs to reduce stagnation of fluid in the dependent extremity.
Wear proper, well-fitting footwear and hosiery
Support the at-risk limb with a compression garment for strenuous activity except in patients with open wounds or with poor circulation in the at-risk limb.
NOTE: Given that there is little evidence-based literature regarding many of these practices, the majority of the recommendations must at this time be based on the knowledge of pathophysiology and decades of clinical experience by experts in the field.