viernes, 28 de junio de 2019

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


First, it must be analyzed whether the patient's basic home setting management alone, consisting of skin hygiene, motion exercises, limb elevation, and footwear, is enough to reduce and stop the progression of lymphedema toward the Elephantiasis Stage.


The effectiveness of self-care based on skin care, 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


Lymphedema is a progressive disfiguring and disabling disease of the skin, classified as a functional, immune, and lymphatic circulatory system disorder (Organic Lymphatic Vascular Disease). The lymphatics are an active and integrated component of the immune response, and in lymphedema, there is always an increased susceptibility to infection due to the compromised immune system. Read more about what is an Organic Imparment HERE


Lymphedema arises when there is a disruption of lymphatic flow (Organic Impairment), leading to the buildup of lymphatic fluid. It is clear that no patient or their lymphedema is the same and neither is its progress. Some patients with lymphedema have few symptoms, and can easily do different degrees of physical activity, while others feel the strain, experience increased swelling and minimum effort, or even suffer varying degrees of disability and severe complications. Read more about lymphedema and Infectious Cellulitis 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 the permanent use of wearable compression garments, it is impossible in the majority of cases, to control the chronic progressive swelling of lymphatic edema. Read more about the importance of compression garments in the treatment of lymphedema HERE.


The daily use of standard bandages is not practical, for they tend to loosen and slip off when undertaking work that requires contínuous physical activity, and likewise, soiled bandages can also be an important source of infection. 


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. 


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. Lymphatic 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. 


CLICK TO SEE A VIDEO OF THE BEST TREATMENT OPTION FOR ELEPHANTIASIS-STAGE-4-LYMPHOEDEMA (NON-SURGICAL TREATMENT):



Regarding Secondary Lymphedema due to filarial infection (lymphatic filariasis), some countries have successfully interrupted transmission of filariasis employing 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.



IMPORTANT NOTICE 

Lymphedema is a serious chronic and progressive disease due to lymphatic dysfunction (Organic Lymphatic Vascular Disease). The clinical treatment of lymphedema is neither a cosmetic nor an aesthetic treatment. The treatment of lymphedema is to control its progression and alleviate the symptoms related to dysfunction of the lymphatic circulatory system. 

To prevent and avoid serious complications associated with treatment, such as the possible displacement of edema to previously unaffected areas when compression therapy is applied for volume reduction, patients should use highly specialized and experienced therapists. 

Professional qualification and instruction delivered remotely online are not the same as live hands-on practical instruction in the clinical training and certification of lymphedema therapists, similar to all other rehabilitation, medical, and surgical training programs, and especially for developing the necessary manual skills to treat a disease as complex as lymphedema. 

Patients should also take special care when choosing a Multidisciplinary Expert Center of Reference for Lymphedema, as not all countries and centers provide the same treatment options. The best choice is a center of reference that provides Complete Decongestive Therapy (CDT), which is recognized as the “Gold Standard” treatment for lymphedema.

  • Read more about what is the best treatment option for Lymphedema HERE.
  • Read about what are the principal functions of Manual Lymphatic Drainage HERE.
  • Read about what are the main differences between the two principal lymphedema treatment protocols HERE. 
  • Read about what are the strategies for the implementation of low-cost treatment options for Lymphedema HERE.

REFERENCES

(Click on the texts to read the research articles)

SCIENTIFIC SOCIETIES

PATHOPHYSIOLOGY

CUTANEOUS COMPLICATIONS
INFECTIOUS COMPLICATIONS
CELLULITIS / DERMATOLYMPHANGIOADENITIS
TUMOURS

TREATMENT

COMPRESSION GARMENTS

DISABILITY

DISFIGUREMENT

PSYCHOSOCIAL IMPACT

PEDIATRIC LYMPHEDEMA

LYMPHATIC FILARIASIS / PODOCONIOSIS



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