Letter to the Editor: Folliculitis Associated with Intermittant Pneumatic Compression

To the Editor,

We read with a great interest the article by Won, et al.¹ in which the authors presented a patient with extensive bullous complication associated with intermittent pneumatic compression (IPC). They stated that no skin complication has been reported after the use of IPC so far.¹ Therefore, we would like to share our experience of a patient with folliculitis complication associated with IPC, thus being the second report in the literature.

A 23-year-old man was seen due to his complaint of mild global swelling in the lower extremities. On detailed questioning he told that he was diagnosed with bilateral lower extremity lymphedema and suffering from it for the past 2 years. He was using compression stockings for the treatment of lymphedema, but no drugs. He had no history of skin allergy. The medical and family histories were otherwise non-contributory. He underwent IPC treatment (Daesung Maref Co. Ltd., Gyeonggi-do, Korea) for 30 minutes once a day. On the fifth day of the treatment, he complained of skin lesions on both legs (Fig. 1). The patient was consulted at the Dermatology Department and a diagnosis of folliculitis was made. IPC treatment was terminated and after receiving antibiotherapy for 7 days his skin lesions disappeared completely.

Fig. 1.

(A) The skin lesions of the patient on both legs. (B) Focused image of the skin lesions.

There are two types of lymphedema: primary lymphedema without etiological factors, and secondary lymphedema resulting from lymph node dissection for malignant disorders.² Peripheral lymph transportation is interrupted because of the lymph vessel hypo-function, leading to lymphedema.² Although there is no recently developed advanced effective treatment technique, IPC is recommended by the International Society of Lymphology³ for the treatment of lymphedema and it is one of the commonly used physical modalities in daily practice.

On the other hand, as the lymph vessel function is damaged, bacterial infection may become more troublesome because of increased capillary permeability due to inflammation in the affected limbs.² To prevent infection of affected limb, it is important to clean the skin and the cuff of the device. Furthermore, considering the risk of lymph vessel injury, strong compression for a long duration should be avoided.² Therefore, when IPC device is applied to patients with lymphedema, as stated by Won, et al.,¹ skin condition of the limbs should frequently be checked during the application.