miércoles, 7 de agosto de 2019

WHAT IS THE RISK OF DERMATOLYMPHANGIOADENITIS-DLA (INFECTIOUS CELLULITIS) IN LYMPHEDEMA - What is the best Preventive Treatment – Pediatric and Primary Lymphedema - Secondary Lymphedema - Lymphatic Filariasis and Podoconiosis - Lymphostatic Elephantiasis - Rare Disease

Dermatolymphangioadenitis-DLA (also known as Infectious Cellulitis) is a common and serious bacterial infection of the deeper layers of the skin, due to obstructive peripheral lymphedema which deteriorates lymphatic function, and in advanced cases needs hospitalization. The most common clinical manifestations of DLA are fever, headache, pain, and inflammation in the affected region, erythema, and vomiting. Infectious cellulitis has a high risk of leading to a life-threatening complication as "Sepsis" (bacteremia). The recommended treatment for infectious cellulitis is antibiotics.




Episodes of acute ADLA are difficult to halt, especially when lymphatic edema is without propper reduction and compression treatment, even with the intervention of hygiene-based measures and limb elevation care. In the early stages of lymphedema, pitting is clear, the skin is soft, and limb elevation may assist in resolving the edema vo, but as the disease progresses pitting ceases, the skin hardens, and elevation does not relieve the swelling. 

All lymphedema whatever the cause or setting
including filariasis and podoconiosis, are chronic edema characterized by progressive swelling and inflammation due to lymphatic dysfunction. The only way to control the clinical manifestations is with compressive therapy and garments. Daily washing of the affected limbs with soap and water and the elevation of limbs are important, but "NOT" the central component in the treatment package that this devastating disease needs.


Effectiveness of washing alone interventions will "NOT" resolve the majority of cases of morbidity, quality of life of patients, or incidence of acute dermatolymphangioadenitis (cellulitis). Chronic lymphedema without volume reduction treatment and compression garments, and the continual abuse of antibiotics administered prophylactically in response to the consequent complications, has a high risk and probability of ending up in a life-threatening complication like "Sepsis" (bacteremia). 

On the other hand, there are select situations and certain severe infections, that antibiotic therapy must be given for a prolonged period of time, and treating the infection outweighs the potential for developing side effects and bacterial resistance. Read more about antibiotic therapy resistance HERE

Lymphedema severity hampers and may "NOT" permit
doing many jobs and house activities, and only with good standard protocols for lymphedema management to reduce limb volume, will this benefit quality of life and disability incidence. With good compression treatment options, overall quality of life increases positively, and disability scores decrease significantly. Click to see the video of the "Best Treatment Option for  Lymphoedema" :


The implementation of educational programs for basic self-care and community-based lymphedema management, as only treatment available, in the majority of cases does not solve the chronic swelling process of mild lymphedema towards Stage III elephantiasis. It is also "NOT" realistic or fair to place the burden of treatment solely on the community or Families, for there are important questions concerning the family ́s time availability regarding their own work schedules, or if they live at far distances. On the other hand, it must be stated, that even with basic self-care and community-based programs, it is impossible for the majority of individuals to perform daily activities and work, without the permanent use of compression garments. 

Without an effective management approach, the majority of lymphatic edema will continue to aggravate towards progressive inflammation, swelling, and major complications. Only with the implementation of good comprehensive lymphedema management programs, will there be a significant decrease of both limb volume and the incidence of infectious cellulitis (dermatolymphangioadenitis-DLA) in lymphostatic edema.


References:

Erysipelas and lymphedema
Foldi E. Prevention of dermatolymphangioadenitis by combined physiotherapy of the swollen arm after treatment for breast cancer. Lymphology. 1996;29:48-49.
Inflammatory Manifestations of Lymphedema
Lymphedema: Pathophysiology and clinical manifestations
Erysipelas and cellulitis: Overview
Towards a better understanding of lymph circulation
https://www.phlebolymphology.org/towards-a-better-understanding-of-lymph-circulation/ 










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