OVERVIEW

What is Lymphangitis?

Lymphangitis is inflammation of the lymphatic vessels caused by infectious or non-infectious factors. The most common cause is the invasion of pathogens into the lymphatic system through skin or mucosal wounds, surgical incisions, etc. The predominant pathogens are hemolytic streptococci and Staphylococcus aureus.

Since the lymphatic system is distributed throughout the body, lymphangitis can occur in any part of the body, most commonly in the limbs, especially the lower extremities. If not treated promptly and effectively, it may lead to severe secondary infections or even sepsis, which can be life-threatening. Seeking medical attention promptly is advised.

How is Lymphangitis Classified or Typed?

Lymphangitis is categorized based on the speed of onset into acute and chronic lymphangitis, and based on the location of the lymphatic vessels into superficial and deep lymphangitis.

1. By speed of onset:

   • Acute Lymphangitis: Caused by pathogens such as beta-hemolytic streptococci or Staphylococcus aureus, which infect lymphatic vessels through skin or mucosal wounds or postoperative incisions, leading to localized or distal inflammatory reactions. Examples include hand infections or tinea pedis, which can spread through tissue lymphatic spaces to the lymphatic vessels, causing conditions like erysipelas in the lower leg.
   • Chronic Lymphangitis: Typically results from unresolved or recurrent acute lymphangitis. Epidemiological factors, lymphatic vessel damage, or developmental defects should also be considered.

2. By lymphatic vessel location:

   • Superficial Lymphangitis: Often occurs in the neck, armpits, groin, or inner elbows, presenting with skin redness, warmth, and pain.
   • Deep Lymphangitis: Usually affects proximal limbs without visible red streaks, manifesting as swelling and tenderness.

Lymphangitis can also occur in non-infectious conditions, such as in cancer or Crohn’s disease patients.

Which Body Parts or Organs Are Affected by Lymphangitis?

The most common cause of lymphangitis is bacterial infection of the lymphatic vessels. Since the lymphatic system is widespread, lymphangitis can occur anywhere in the body, most frequently in the lower extremities.

Based on location, lymphangitis can be classified as superficial or deep. Superficial lymphangitis often affects the limbs, particularly the lower extremities, while deep lymphangitis is hidden within deeper tissues, presenting with cord-like tenderness or nodular swelling along the lymphatic vessels without obvious surface changes.

Acute lymphangitis may cause localized redness, swelling, warmth, and pain, potentially involving swollen lymph nodes in the groin area^[1].

Is Lymphangitis Contagious?

Lymphangitis is an inflammatory condition and is not contagious.

Etiologically, lymphangitis results from pathogens invading the lymphatic system, most commonly hemolytic streptococci and Staphylococcus aureus. Clinical risk factors include weakened immune function, chronic smoking or alcohol use, underlying chronic diseases, or localized skin breakdown—none of which can be transmitted to others.

SYMPTOMS

What are the common symptoms of lymphangitis?

Depending on the location of the affected lymphatic vessels, lymphangitis can be classified as superficial or deep.

Acute episodes of both superficial and deep lymphangitis can cause localized redness, swelling, heat, and pain, accompanied by systemic symptoms such as fever, headache, loss of appetite, and chills.
Superficial lymphangitis commonly affects the limbs, especially the lower extremities. A distinctive "red line" or streaky erythema can be seen spreading rapidly beneath the skin, with noticeable swelling and tenderness along the affected area. In the upper limbs, the red line may extend to the elbow or armpit, while in the lower limbs, it may reach the popliteal fossa (behind the knee) or even the groin.

Deep lymphangitis, however, is hidden deeper within the body, with no obvious visible changes on the surface, but may present as cord-like tenderness.

What complications can lymphangitis cause?

If lymphangitis is not treated promptly and effectively, it may lead to complications such as localized ulceration or abscess formation.

Additionally, the central area of infection may become suppurative, and bacteria traveling along the lymphatic vessels can infect nearby lymph nodes, causing lymphadenitis or even abscess formation in the nodes.

If the condition spreads further, bacteria may enter the bloodstream, leading to severe complications like systemic bacteremia or sepsis. In extreme cases, severe infection can be fatal.

CAUSES

What are the causes of lymphangitis?

Lymphangitis is caused by pathogen infection, along with decreased local immunity or skin breaks in the affected area, which are also significant contributing factors.

Lymphangitis is an inflammatory condition resulting from pathogen infection, most commonly by Streptococcus pyogenes and Staphylococcus aureus^[1]. Animal bites (e.g., from cats or dogs), herpes simplex infections on limbs or genitals, and filarial infections can also lead to lymphangitis.

Additionally, weakened immunity is another cause. When a patient's immune system is compromised, even minor bacterial infections—such as through broken skin—can allow bacteria to enter the lymphatic system, triggering localized lymphangitis.

Who is more prone to lymphangitis?

Individuals with athlete’s foot, immunocompromised conditions, or diabetes are at higher risk of developing lymphangitis^[2].

1. Athlete’s foot patients: Since lymphangitis is an inflammatory disease caused by bacterial or fungal infections, skin breaks (e.g., from athlete’s foot or trauma) allow pathogens to enter the lymphatic system, leading to lymphangitis.
2. Immunocompromised individuals: Such as late-stage cancer patients, as lymphangitis is also associated with weakened immunity, making localized infections more likely.
3. Diabetic patients: Their naturally lower immunity and elevated blood sugar levels can cause even minor bacterial infections to spread rapidly, worsening inflammation and increasing the risk of lymphangitis.

Is lymphangitis hereditary?

Lymphangitis is an inflammatory condition caused by pathogen infection and is not hereditary.

DIAGNOSIS

Under what circumstances should patients with lymphangitis seek medical attention promptly?

Patients with lymphangitis should seek medical attention promptly when there is localized skin redness, significant pain, or even fever.

Lymphangitis is an acute inflammatory condition caused by infection, which can lead to localized skin redness, heat, high tension, as well as systemic symptoms such as fever.

If the patient experiences localized skin redness or fever, it indicates a more severe condition with rapid and acute progression, requiring timely hospital treatment.

Which departments should patients with lymphangitis visit?

Patients with lymphangitis are advised to visit the general surgery and dermatology departments.

What preparations should patients with lymphangitis make before seeking medical attention?

Before seeking medical attention, patients with lymphangitis should bring all necessary documents and, if possible, carry personal belongings, as hospitalization may be required.

What tests are generally needed to diagnose lymphangitis?

Lymphangitis is typically diagnosed through physical examination, laboratory tests, local ultrasound examination, and pathogen detection.

• Physical examination: For lymphangitis, a physical examination is the first step to identify skin damage, wounds, or other potential entry points for pathogens. Superficial lymphangitis may present with localized skin redness or even cord-like red lines, while deep lymphangitis may involve hardened skin, palpable cords, and tenderness upon pressure.
• Laboratory tests: Tests such as complete blood count (CBC) and procalcitonin can reveal elevated white blood cells, neutrophils, or procalcitonin levels, helping assess the presence and severity of infection.
• Local ultrasound examination: Ultrasound can further clarify the condition by detecting localized tissue inflammation or other related abnormalities.
• Pathogen detection: If an abscess forms, the doctor may perform a puncture to aspirate and sample the fluid for pathogen detection to identify the infectious agent.

What questions do doctors frequently ask patients with lymphangitis during consultations?

During consultations, doctors often ask the following questions to quickly assess the condition. Patients can prepare answers in advance:

1. What symptoms are present? Have they worsened? How long have they persisted?
2. Is there any injury or ulcer near the affected area? What caused it?
3. Apart from skin symptoms, are there any other discomforts?
4. Do you have any underlying medical conditions? Are you taking any medications?
5. Is this the first occurrence of these symptoms, or have they happened before?

TREATMENT

What treatments are generally required for patients with lymphangitis when they go to the hospital?

For lymphangitis, the following treatments are generally required when visiting the hospital:

Antimicrobial therapy is key to treating lymphangitis. For non-suppurative infections, empirical antibiotic treatment is usually administered. For patients with drainable abscesses, incision and drainage should be performed. Some cases of nodular lymphangitis require surgical debridement. Patients with significant lymphatic obstruction due to lymphedema may also undergo surgical treatment.

What are the common medications for lymphangitis?

Common topical medications for lymphangitis include bactericidal agents such as nitrofurazone solution. Commonly used oral antibiotics include dicloxacillin, cephalexin, cefuroxime, ceftriaxone, clindamycin, nafcillin, and trimethoprim.

What are the consequences of not treating lymphangitis promptly?

If lymphangitis is not treated promptly, it may lead to further spread of inflammation, recurrent fever, or even systemic infection.

Lymphangitis is a condition caused by pathogens such as bacteria or fungi. Without timely treatment, the inflammation may worsen, leading to increased pain, more extensive redness and swelling, excessive tension, and even skin ulceration or abscess formation.

Additionally, if bacteria enter the bloodstream, systemic infection may occur, often manifesting as chills and high fever. Further progression of the infection may lead to sepsis or septicemia.

Therefore, patients with lymphangitis should seek medical treatment promptly.

Can lymphangitis heal on its own?

Lymphangitis usually does not heal on its own and requires active intervention.

Lymphangitis is an inflammatory disease caused by bacterial infection. Antibiotic treatment is typically necessary for the condition to gradually improve and heal. Without treatment, it is unlikely to resolve spontaneously and may worsen, potentially leading to complications such as skin ulceration, abscess formation, or chronic lymphangitis and lymphedema.

Can lymphangitis be cured? Will it recur?

Lymphangitis can be cured, but there is a certain recurrence rate.

Lymphangitis is an inflammatory condition caused by bacterial infections such as group A beta-hemolytic streptococcus. With effective antibiotic treatment, the inflammation can be controlled, and the condition can heal. However, if predisposing factors are not completely eliminated, recurrence may occur when immunity is compromised. Common triggers include athlete's foot or diabetes. If these conditions worsen or blood sugar levels fluctuate significantly, lymphangitis may recur.

Therefore, after treatment, patients should address the underlying causes. For example, athlete's foot should be treated, and diabetic patients should monitor and control their blood sugar levels.

DIET & LIFESTYLE

What should patients with lymphangitis pay attention to in daily life?

Patients with lymphangitis should pay attention to the following in daily life:

1. First, patients need to rest adequately, avoid overexertion, and refrain from high-intensity exercise.
2. It is recommended to improve lifestyle habits, quit smoking and alcohol, maintain a light diet, avoid spicy and irritating foods, and eat more vegetables and fruits.
3. Take medications as prescribed by the doctor to completely eliminate pathogens and prevent recurrence.
4. When experiencing pain in the affected area, local cold or warm compresses can be applied to relieve discomfort.
5. While treating lymphangitis, it is also necessary to actively control inflammation to prevent recurrence.

How should patients with lymphangitis exercise?

Patients with lymphangitis are advised to engage in moderate exercise, such as slow walking. Avoid moving too quickly to prevent increased local pain. Strenuous exercise should be avoided, as it may worsen pain and even spread inflammation further.

For patients who have recovered, moderate exercise is still recommended in daily life. Prolonged sitting or standing should be avoided, and skin infections should be treated promptly.

What foods should patients with lymphangitis avoid in their daily diet?

The daily diet of lymphangitis patients should be light and rich in vitamins. Spicy, irritating, and greasy foods should be avoided, as well as smoking and alcohol.
Foods that patients with lymphangitis should avoid include:

1. Spicy and irritating foods: such as chili peppers, mustard, curry, ginger, and Sichuan pepper, as they may hinder recovery.
2. Greasy foods: such as fried chicken, fried ribs, roasted duck, roasted goose, fatty meat, chicken skin, and pork skin. These foods may increase blood viscosity and lipid levels, potentially impairing circulation and vascular elasticity, which is unfavorable for recovery.
3. Smoking and alcohol: Long-term drinking and smoking are risk factors for lymphangitis, as they can increase vascular fragility. Therefore, they should be strictly avoided.

How should patients with lymphangitis monitor their condition and follow up?

Patients with lymphangitis should observe whether there is redness, swelling, or pain in the affected skin. If any discomfort occurs, prompt follow-up is necessary.

Generally, a follow-up examination is recommended 1–2 weeks after treatment to assess recovery. In daily life, patients should maintain a light diet, eliminate triggers, and prevent recurrence of lymphangitis.

PREVENTION

Can lymphangitis be prevented? How to prevent it?

Lymphangitis can be prevented, and the most important measure is to avoid skin infections. Therefore, patients are advised to address local causes for prevention and promptly treat skin injuries and infections^[3].

For patients prone to skin infections, such as those with diabetes, it is essential to maintain good blood sugar control, protect the skin (especially the feet), and reduce the risk of infections and ulcers.

Additionally, patients with lower limb skin ulcers or athlete's foot should seek timely treatment to prevent bacteria from entering the lymphatic system, which could worsen the condition^[4,5].

In daily life, patients are advised to avoid prolonged sitting or standing and to engage in regular movement to promote lower limb blood circulation.

Which lifestyle habits may contribute to lymphangitis?

Poor skin hygiene and prolonged sitting can easily lead to lymphangitis.

Lymphangitis is caused by bacterial or other pathogen infections, often resulting in localized redness and warmth. Common bacteria enter the lymphatic vessels through the feet, and many patients develop the condition due to athlete's foot. Therefore, patients with foot ulcers or athlete's foot should seek timely treatment.

Moreover, prolonged sitting may impair lower limb blood circulation and lymphatic drainage, increasing the risk of lymphangitis if a bacterial infection occurs.