viernes, 28 de junio de 2019

WHAT IS THE BEST TREATMENT OPTION FOR ELEPHANTIASIS – Pediatric and Primary Lymphedema -Secondary Lymphedema - Lymphatic Filariasis – Podoconiosis - Dermatolymphangioadenitis (DLA) – Rare Disease - Choosing an Lymphedema Expert Reference/Excellence Centre

First, it must be analyzed whether patient basic home setting management alone, consisting of skin hygiene, motion exercises, and limb elevation, is enough to reduce and stop the progression of lymphedema towards Stage-III-elephantiasis.

The effectiveness of self-care based on skincare, motion exercises, and limb elevation interventions on lymphedema, is part of a basic daily-care routine for patients and meant for the prevention of possible dermal infections, but without compression therapy, this is not enough to stop dermatolymphangioadenitis - DLA (cellulitis), erysipelas, lymphangitis, or the progressive swelling of edema. Clinical outcomes on interventions to manage lymphedema, show that simple hygiene-based measures are necessary, but this alone will not reduce the limb volume. Read more about the signs, symptoms, and complications of lymphoedema HERE.

All lymphedema whatever the cause or setting, needs compression therapy and compression garments as treatment, to hold back the progression of the disease. Without daily use of wearable compression garments, it is impossible in the majority of cases, to control the chronic progressive swelling of lymphatic edema. Elephantiasis is the advanced form of all Lymphedema whatever the cause and, special care is necessary for volume reduction and disability management. 

The First-line treatment for elephantiasis is Complete Decongestive Therapy (CDT), which is considered the "Gold Standard" conservative treatment for the reduction and maintenance of limb volume. This specialized treatment consists of  Manual Lymphatic Drainage (MLD) and Multi-layer bandage wrapping conducted by specialized therapists, as well as other components such as skin care, diet, and exercise. Radical reductive ablative surgery (Charles Procedure), aimed to remove the subcutaneous tissue, should always be the last option, for it is frequently associated with significant blood loss, morbidity, infections, permanent disfigurement, and recurrence of symptoms. 

Patients should be especially careful when choosing a lymphedema "Multidisciplinary Expert Centre of Reference/Excellence", as not all centers and counties offer or provide the same treatment options. The best choice is the Expert Reference Centre which applies Complete Decongestive Therapy (CDT), which is recognized as the "Gold Standard" treatment for lymphedema. Read more about which components form part of the conservative Gold Standard treatment for Lymphedema HERE.
lymphedema without compression treatment and garments, even with the intervention of simple hygiene-based measures and elevation of limbs, is not enough to control inflammatory episodes of bacterial dermatolymphangioadenitis (DLA). Available evidence strongly supports the effectiveness of the management of lymphedema with correct volume reduction therapy and compression garments, to control the progression and advance of the disease. Treatment with Complete Decongestive Therapy (CDT) and compression garments achieves predictable results, showing dramatic functional (disability) and aesthetic (disfigurement) improvement, and a high overall satisfaction rate in terms of quality of life.

International protocols and best practice guides recommend simple hygiene-based measures for almost all diseases, but in the case of lymphedema this is not enough for its volume control, and to prevent the progression of its severe clinical manifestations. Lymphostatic edema without treatment or under-treated is more likely to develop lethal complications, such as septicemia (sepsis) or lymphangiosarcoma. Read more about which country provides the best lymphedema treatment coverage HERE. 

With reference to Secondary Lymphedema due to filarial infection (lymphatic filariasis), there are countries that have successfully interrupted transmission of filariasis by means of mass treatment with antiparasitic drugs, but access to good compression treatment and compression garments to prevent morbidity management and disability in established lymphedema has lagged behind, and so people continue to suffer from the disabling and stigmatizing effects of Lymphedema Stage III-elephantiasis.




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