Lymphedema is swelling of an arm or leg that happens when lymph fluid cannot drain properly. To reduce the swelling, people use multilayer compression bandages and compression garments (such as compression stockings), and this compression therapy is central to controlling the swelling. However, because compression applies steady pressure to the skin, fragile skin can become red, peel, or blister.
There are several common reasons skin gets damaged. First, a poor fit: a garment that is too tight, or that wrinkles and folds at spots like the ankle crease or behind the knee, concentrates pressure and creates friction and shear at that point. Second, rubbing of the fabric against the skin while walking or moving. Third, sweat and moisture — after an hour of walking on a warm day, the inside of the stocking becomes damp and the skin barrier softens and weakens. Fourth, contact dermatitis, a red and itchy reaction to the fabric, laundry detergent, or moisturizer ingredients. Fifth, lymphedema itself thickens and dries the skin, so it cracks more easily.
The main thing to watch for is infection. A limb with lymphedema has weakened lymph circulation and a reduced ability to fight off bacteria. A small wound or a patch of broken skin can become a doorway for bacteria and spread into cellulitis. If the area suddenly becomes widely red, hot, and painful with a fever, treat it as an emergency.
Daily skin care is straightforward. After washing, pat the skin gently dry and apply a low-fragrance moisturizer to protect the skin barrier. Avoid applying a thick layer right before putting on the stocking, since it makes the garment slip and can degrade the fabric — apply at night or wait until it is fully absorbed. Care for the toenails, spaces between the toes, and any athlete's foot to reduce wounds and paths for infection. When putting the stocking on, smooth it out so no wrinkles form, and using a donning aid such as gloves can reduce scratches from fingernails.
If your skin has already been damaged, rather than forcing the same stocking back on, it is better to show the area to your doctor or a lymphedema therapist and discuss it. The compression class (strength) or size may need to be checked, the material may need changing, or a temporary return to bandaging may be needed. Stopping compression entirely on your own can let the swelling return, so the principle is to readjust rather than to quit.
Contact your care team without delay if you notice spreading redness with warmth, pain, and fever (possible infection); blisters, oozing, or wounds that will not heal; numbness or skin that turns white or blue (too tight); or a sudden increase in swelling.
This article is for general information only and does not replace individual medical care. Any change to your skin condition or compression therapy should be decided in consultation with your own doctor or lymphedema therapist.