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, inflammation in the affected region, erythema, and vomiting. Infectious cellulitis has a high risk of leading to life-threatening complications such 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 proper 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, 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.
The 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 compression treatment and 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 without compression therapy and garments, as the only treatment available, in the majority of cases does not solve the chronic swelling process of mild
lymphedema towards Stage III elephantiasis. On the other hand, the burden of treatment can not be placed 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. 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 access and 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 proper lymphedema management programs, will there be a significant decrease in both limb volume and the incidence of infectious cellulitis (dermatolymphangioadenitis-DLA) in lymphatic 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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