Leamington Lymphoedema Clinic
At Leamington Lymphoedema Clinic assessment and treatment is provided by Helen Stanley, a Chartered Physiotherapist and Registered Nurse. Helen hold an MSc in Health Care and is registered with the Health Professions Council/Nursing and Midwifery Council.
Please note Helen can only accept NHS referrals.
Helen can be contacted directly on 07760 166046.
The Cloisters, Lower Leam Street, Leamington Spa, Warwickshire, CV31 1DA Tel: 01926 316 420 – 01926 316420 Mobile: 07760166046 Email: contact@lymphoedemaclinic.co.uk
Lymphoedema Service Myton Hospice Warwick
Based at Warwick Myton Hospice for patients of Coventry, Rugby and South Warwickshire.
For management of lymphoedema secondary to cancer and/or its treatment, with the aim of reducing and relieving symptoms of lymphoedema.
The swelling can affect arms, legs, body, head or genitals, and may cause heaviness, pain, tightness, loss of function, dry/hardened skin and make the patient more susceptible to episodes of cellulitis (inflammation of the tissues).
For more information please call 01926 838 806 or email Lymphoedema.clinic@mytonhospice.org
Referral form: see link on right of page
Cellulitis and Lymphoedema
When should I admit or refer a person with cellulitis? (See NICE CKS Rev Jan 2021)
- Arrange urgent hospital admission if the person:
- Has Class IV cellulitis (sepsis or severe life-threatening infection, such as necrotizing fasciitis).
- Has Class III cellulitis (significant systemic upset, such as acute confusion, tachycardia, tachypnoea, hypotension, or unstable comorbidities, or a limb-threatening infection due to vascular compromize).
- Has severe or rapidly deteriorating cellulitis (for example extensive areas of skin).
- Is very young (under 1 year of age) or frail.
- Is immunocompromised.
- Has significant lymphoedema.
- Has facial cellulitis (unless very mild).
- Has suspected orbital or periorbital cellulitis (admit to ophthalmology).
- Has Class II cellulitis (systemically unwell or systemically well but with a comorbidity).
- Admission may not be necessary if the facilities and expertise are available in the community to give intravenous antibiotics and monitor the person (check local guidelines).
- Has symptoms or signs suggesting a more serious illness or condition (such as osteomyelitis, or septic arthritis).
- Consider referring people to hospital, or seek specialist advice, if they:
- Are severely unwell.
- Have infection near the eyes or nose (including periorbital cellulitis).
- Could have uncommon pathogens, for example, after a penetrating injury, exposure to water-borne organisms, or an infection acquired outside the UK.
- Have spreading infection that is not responding to an oral antibiotic.
- Have lymphangitis.
- Cannot take oral antibiotics (exploring locally available options for giving intravenous antibiotics at home or in the community, rather than in hospital, where appropriate).
- For cellulitis resulting from a wound contaminated with fresh water or sea water:
- Seek specialist advice from a medical microbiologist.
- Seek specialist advice or consider admission, depending on clinical judgement, if:
- There is continuing or deteriorating systemic signs, with or without deteriorating local signs, after 2–3 days of treatment.
- Symptoms are not improving (or are worsening) after 14 days of treatment.
- If a person has recurrent episodes of cellulitis (more than two episodes at the same site within one year), consider routine referral to secondary care for advice on the use of prophylactic antibiotics.
How should I manage acute cellulitis in primary care?
- For people with Class I cellulitis (no signs of systemic toxicity and no uncontrolled comorbidities):
- Prescribe a high-dose oral antibiotic treatment.
- Before treatment, draw around the extent of the infection with a permanent marker pen for future comparison and to track the spread of infection. This may be difficult in people with lymphoedema as the rash is often blotchy.
- Advise the person to:
- Take paracetamol or ibuprofen for pain and fever. For detailed information on prescribing these analgesics, see the CKS topic on Analgesia – mild-to-moderate pain.
- Drink adequate fluids.
- Seek immediate medical advice if antibiotics are not tolerated, the cellulitis becomes worse (there may be an increase in the redness in the first 24–48 hours of treatment possibly due to release of toxins), or if systemic symptoms develop or worsen.
- Elevate the leg for comfort and to relieve oedema (where applicable).
- Avoid the use of compression garments during acute cellulitis.
- Manage any underlying risk factors for cellulitis.
- Manage breaks in the skin, for example, due to eczema, tinea pedis, or leg ulcers, which may become a portal of entry for organisms. See the CKS topics on Eczema – atopic, Venous eczema and lipodermatosclerosis, Fungal skin infection – foot, and Leg ulcer – venous for management information.
- Manage venous insufficiency. See the CKS topic on Venous eczema and lipodermatosclerosis for management information.
- Consider referring people with lymphoedema to a specialist clinic.
- Liaise with a district nurse if there is skin blistering, broken skin, exudate, or venous ulceration.
- Identify and manage comorbidities (such as diabetes mellitus) that may cause the cellulitis to spread rapidly, or delay healing.
- Advise on preventative measures to reduce the risk of recurrence, including:
- Weight management if the person is obese. For more information, see the CKS topic on Obesity.
- The use of emollients to prevent dry skin and cracking.
- Provide patient information on cellulitis. For example:
- Review the person after 2-3 days depending on clinical judgement, or if local symptoms deteriorate (such as redness or swelling beyond the initial presentation), have severe pain, or they develop systemic symptoms.
- If a person has recurrent episodes of cellulitis (more than two episodes at the same site within one year), consider routine referral to secondary care for advice on the use of prophylactic antibiotics.
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