Management of Lymphedema Dermatitis

Immediate Priorities: Infection Control and Skin Care

The American Academy of Pediatrics recommends initiating antibiotics immediately with a penicillinase-resistant penicillin, first-generation cephalosporin, or clindamycin/vancomycin for penicillin-allergic patients for active cellulitis/erysipelas 1
Treatment duration of 5 days of antibiotics is as effective as 10 days for uncomplicated cellulitis, according to the Infectious Diseases Society of America 1
Adjunctive corticosteroids, such as an 8-day tapering course starting with 30 mg prednisolone, can hasten resolution of uncomplicated cellulitis/erysipelas, as suggested by the Clinical Infectious Diseases journal 1
Elevation of the affected limb is critical to promote gravity drainage of edema and inflammatory substances, as recommended by the Clinical Infectious Diseases journal 1, 4
Preventing skin breakdown by keeping skin well-hydrated is essential to avoid dryness and cracking, which serve as portals for bacterial entry, according to the Clinical Infectious Diseases journal 1, 4
Treating interdigital maceration, including fungal infections, is necessary to prevent cellulitis, as recommended by the Clinical Infectious Diseases journal 1, 4

Monthly intramuscular benzathine penicillin, 1.2 million units in adults, can be used as prophylaxis, as suggested by the Clinical Infectious Diseases journal 1, 4
Oral prophylaxis with either erythromycin 250 mg twice daily or penicillin V 1 g twice daily can be used, according to the Clinical Infectious Diseases journal 1, 4
Patient-initiated therapy with oral antibiotics can be provided to reliable patients to start immediately at first signs of infection, as recommended by the Clinical Infectious Diseases journal 1

The British Medical Journal recommends using the least potent topical corticosteroid preparation required to control dermatitis 5
Stopping topical corticosteroids for short periods when possible can help minimize side effects, as suggested by the British Medical Journal 5
Keeping nails short can minimize damage from scratching, according to the British Medical Journal 5

Dermatology consultation is recommended for management of chronic dermatitis and monitoring for secondary complications, as suggested by the American Academy of Pediatrics 2, 3
Vascular specialist/lymphedema clinic referral is necessary for comprehensive lymphedema management and complex decongestive therapy, according to the American Academy of Pediatrics 2, 3
Annual evaluation is necessary to monitor for progression and adjust treatment accordingly, as recommended by the American Academy of Pediatrics 2, 3