Is Weeping Skin a Sign That Death Is Near?

Weeping skin is not, on its own, a sign that death is near. Fluid leaking through the skin usually comes from swelling (edema) in the legs, which can last for months, and it is not on the National Cancer Institute's list of changes in the final days of life. In a seriously ill person it does deserve attention, because leaking skin breaks down easily and can become infected, so tell the hospice nurse when you see it.

Families often notice it at a frightening moment: legs that look tight and shiny, damp sheets, clear or yellowish fluid beading on the skin. Here is what is known about why it happens, what it does and does not mean, and how hospice cares for it.

What weeping skin usually is

MedlinePlus, the National Library of Medicine's consumer health site, defines edema as swelling caused by fluid in the body's tissues, usually in the feet, ankles, and legs. When poor circulation in the leg veins causes stasis dermatitis, MedlinePlus explains that fluid and blood cells leak out of the veins into the skin and other tissues, and the skin can become red or swollen, crusted, or weepy.

Leg swelling has many causes. MedlinePlus and the National Cancer Institute (NCI) list, among others:

• Heart failure, kidney failure, and liver failure
• Some cancers, and some cancer treatments
• Certain medicines, including steroids, some blood pressure medicines, and anti-inflammatory pain relievers
• Problems with the lymph nodes or lymphatic drainage
• Long periods of sitting or lying in one position

Several of these are common in people receiving hospice care, which is why swollen, leaking legs are a familiar sight to hospice nurses. If your loved one has heart failure, our guide to hospice care for congestive heart failure explains how the team manages fluid overload.

Does it mean death is near?

Not by itself. The NCI's list of changes in the final days and hours of life includes hands and feet that become blotchy, cold, or blue, passing less urine, breathing changes, and sleeping more. Weeping skin is not on that list, and we found no official source that treats it as a sign of imminent death.

What the research does show is that swelling can go on for a long time. A 2016 study in the Journal of Palliative Medicine (indexed on the National Library of Medicine's PubMed, PMID 27078226) looked at 63 patients referred to one specialist palliative care edema service. Fluid leakage (lymphorrhea) occurred in 9.5% of them and the authors called it a relatively poor prognostic sign, but they also noted that edema can be present for many months before death. In other words, it can reflect how advanced an illness is without telling you how much time is left.

If you are worried about timing, the hospice nurse can look at the whole picture. Changes such as mottled skin, breathing changes, and much less urine say more about the final days than leaking legs do.

How hospice cares for weeping skin

Medicare's hospice benefit covers nursing care, and medical supplies that are in the written plan of care for managing the terminal illness and related conditions (42 CFR 418.202). In practice, care for leaking skin is usually aimed at comfort and protecting the skin rather than eliminating the swelling. Depending on your loved one's condition, the nurse may:

• Check and protect the skin. Wet skin breaks down more easily. The nurse may use absorbent pads or dressings and change them as needed, and teach you to do the same between visits.
• Raise the legs when it is comfortable. MedlinePlus suggests putting the legs on pillows to raise them above the heart while lying down.
• Keep clothing loose. The NCI notes that tight clothing, shoes, and jewelry can make swelling worse.
• Keep skin from drying and cracking. The NCI advises lotion to keep skin from drying and cracking, and MedlinePlus suggests asking the care team before using any lotion, cream, or ointment on irritated leg skin.
• Review medicines and fluids. For some conditions, such as heart failure, the team may adjust diuretics. In the final days, the NCI notes that giving fluids has not been shown to help patients live longer or improve their quality of life; see should you force food and water at the end of life.
• Reposition regularly to relieve pressure, since fragile, swollen skin is also at risk for pressure sores. Our guide to how hospice treats bedsores covers that side of skin care.

MedlinePlus and the NCI both mention compression stockings or garments as a treatment for leg swelling. For someone on hospice, use them only if the hospice team recommends them.

When to call the hospice nurse

Hospices must make nursing services available 24 hours a day, 7 days a week (42 CFR 418.100). Call the hospice line, rather than waiting for the next visit, if you notice:

• Redness, warmth, pain, or tenderness in the swollen area, or a fever, which the NCI and MedlinePlus list as possible signs of infection (cellulitis)
• Swelling that suddenly gets worse, moves up the legs, or is new in only one leg
• Open sores or skin that is breaking down
• Shortness of breath or chest pain

For people who are not on hospice, MedlinePlus advises calling 911 for shortness of breath or chest pain with swelling. If your loved one is on hospice, call the hospice's 24-hour number first; the nurse can advise you right away and come out if needed.

Frequently asked questions

What is the fluid leaking from my loved one's legs?

Usually it is fluid from swollen tissue seeping through the skin. MedlinePlus describes edema as fluid trapped in the body's tissues and notes that, with vein problems in the legs, fluid leaks into the skin and the skin can become weepy. The nurse can confirm what it is and check for infection.

Is grey or discolored skin a sign of death?

The NCI lists hands and feet that become blotchy, cold, or blue among the changes in the final days. A color change alone is not a reliable clock, though, and leg swelling and vein problems can also discolor the skin. Ask the hospice nurse to assess it alongside other signs.

Is weeping skin painful?

It can make the skin sore and fragile, and stretched, swollen legs can feel heavy or achy. Tell the nurse if your loved one seems uncomfortable so dressings, positioning, and pain medicine can be adjusted.

Will hospice stop the swelling?

Sometimes it can reduce it, for example by adjusting medicines or positioning, but the main goal is comfort and protecting the skin. The approach is written into the plan of care and changes as your loved one's needs change.

What to do next

If your loved one's legs are leaking fluid, call the hospice nurse to have the skin checked and to get the right pads, dressings, and instructions. If your loved one is seriously ill and not yet on hospice, you can compare hospices near you and ask for an evaluation.