Care of oedematous skin in a resource-poor environment: A commentary of practice strategies to address a global community need.
The emphasis of this paper is to discuss low-cost, self-help interventions for oedematous skin which can be utilised in low-resource communities or settings. In particular, the emerging understanding of the role of epidermal cytokines in repair, as a source of stimulating dermal oedema will be overviewed. Venous overload, due to gravitational effects, is a common contributor to lower limb oedema. A combination of epidermal cytokine activity and chronic ambulatory venous hypertension can overload a failing lymphatic system which, in the absence of overload, may not develop lymphoedema. The epidermis may switch off cytokine production when transepidermal water loss is reduced by appropriate washing and emollient application. Venous overload is helped by elevation and ankle movements, whilst breathing aids both lymphatic and venous drainage. These are low-cost selfhelp interventions which have been found to be helpful in resource-poor countries and can be recommended and promoted in the management of lymphoedema in a wide range of health care settings and environments.