WHAT ARE THE RECOMMENDATIONS AND PREVENTIVE MEASURES TO REDUCE DERMATOLYMPHANGIOADENITIS (DLA) AND ADENOLYMPHANGITIS (ADL) IN LYMPHEDEMA - What are the side effects of taking antibiotics long-term - Pediatric and Primary lymphedema - Secondary Lymphedema - Lymphatic Filariasis and Podoconiosis - lymphoestatic Elephantiasis - Rare Disease

Dermatolymphangioadenitis (also called infectious cellulitis) is an infection of the deep layers of the skin, and erysipelas is an infection of the upper layers. Both infections can also overlap. Adenolymphangitis is an inflammatory condition involving lymph nodes (adenitis) and/or lymph vessels (lymphangitis). 

In Lymphatic Vascular Disease, the "best available recommendation" to prevent repeated episodes of dermatolymphangioadenitis (DLA) and adenolymphangitis (ADL), is to improve skin health and reduce and stabilize the limb volume and circumference of the lymphedematous limb. Early treatment of edema is necessary for skin integrity in the long term, and thus to prevent possible systemic bacterial inflammatory responses, and further lymphatic damage and dysfunction. Read more about what is the risk of Dermatolymphangioadenitis - DLA (Infectious Cellulitis) HERE. 

The principle aim of lymphedema physiotherapy treatment is the same for Primary Lymphedema, as well as for all Secondary lymphoedema whatever the cause or setting. All Primary Lymphedema as well as Secondary Lymphedema like Cancer-related (CR-LE) and filariasis-related lymphedema (FR-LE), basically represent the same disease and need exactly the same treatment and best practice clinical guidelines. 

The "Gold Standard" treatment for lymphedema, consisting of Complete Decongestive Therapy (CDT) and the use of compression garments, is recommended to help stop and reverse edema circumference and volume formation, and so help reduce the incidence rate of hospitalization for the management of recurrent complications like cellulitis and lymphangitis. Effective management of chronic lymphedema improves the physical condition of a person’s skin, which plays a central role in predisposition to complications. Read more about what is the best treatment for lymphedema HERE.

Reducing the "predisposing conditions" by means of basic self-care, consisting of dermis hygiene and hydration (to avoid fungal infections and dry and cracked skin), and simultaneously reducing the oedematous limb by means of physical therapy and compression garments, is agreed as best practice for the management of lymphedema (ISL International Consensus Document).

With reference to non-treatment o under-treatment of lymphedema and the consequent abuse of antibiotics, there are studies state that the protective effects of antibiotics do not last after prophylaxis has been stopped, and also that taking them too often may lead to a dangerous rise in bacteria that no longer respond to medicine. Antibiotic-resistant infections can lead to longer hospital stays, higher treatment costs, and more deaths due to bacteremia (bacteria present in the bloodstream). 

Bacteriemia can progress to systemic inflammatory response syndrome (SIRS), "Sepsis" (septicemia), septic shock, and multiple organ dysfunction syndromes (MODS). 

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.

Many Vascular Surgeons and dermatologists specializing in lymphatic vascular disease agree, that treating the underlying risk factors is the most effective approach for the "prevention" of recurrent infectious cellulitis (dermatolymphangioadenitis) and adenolymphangitis. 

REFERENCES:

A brief multi-disciplinary review on antimicrobial resistance in medicine and its linkage to the global environmental microbiota
https://www.ncbi.nlm.nih.gov/pubmed/23675371?dopt=Abstract

Using medication: Using antibiotics correctly and avoiding resistance
https://www.ncbi.nlm.nih.gov/books/NBK361005/

Effects of Long Term Antibiotic Therapy on Human Oral and Fecal Viromes.

https://www.ncbi.nlm.nih.gov/pubmed/26309137?dopt=Abstract

Resistance to antibiotics: are we in the post-antibiotic era?

https://www.ncbi.nlm.nih.gov/pubmed/16216651?dopt=Abstract

Erysipelas and lymphedema

https://www.phlebolymphology.org/erysipelas-and-lymphedema/

Consensus Document on the Management of Cellulitis in Lymphoedema. British Lymphology Society (BLS) 

https://www.lymphoedema.org/images/pdf/CellulitisConsensus.pdf

Towards a better understanding of lymph circulation

https://www.phlebolymphology.org/towards-a-better-understanding-of-lymph-circulation/

Diagnosis and management of lymphatic vascular disease

https://www.ncbi.nlm.nih.gov/pubmed/18755341

Effects of Complete Decongestive Therapy on the Incidence of  Cellulitis

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4616085/

Consensus Document of the International Society of Lymphology (ISL)

https://www.internationalsocietyoflymphology.org/wp-content/uploads/2017/12/20106-35060-1-PB.pdf

Conservative Treatment of Lymphoedema. Ethel Földi, M. Földi, H. Weissleder

https://journals.sagepub.com/doi/10.1177/000331978503600306

Foldi E. Prevention of dermatolymphangioadenitis by combined physiotherapy of the swollen arm after treatment for breast cancer. Lymphology. 1996;29:48-49.

Articles that may also interest you: 
(Click on the texts)

• FOCUS ON THE TERM ELEPHANTIASIS AND ITS IMPLICATIONS FOR LYMPHOEDEMA 

• WHAT IS THE RISK OF DERMATOLYMPHANGIOADENITIS (INFECTIOUS CELLULITIS IN LYMPHEDEMA 

• WHAT IS THE BEST TREATMENT OPTION FOR ELEPHANTIASIS

• WHY IS ELEPHANTIASIS A FORGOTTEN AND NEGLECTED DISEASE

• IS THERE DISTRESS ASSOCIATED WITH UNDER-TREATMENT OF LYMPHEDEMA - PSYCHOLOGICAL CONSEQUENCES

• WHY IS THE WORLD NOT TREATING A TREATABLE DISEASE LIKE LYMPHEDEMA. 

• WHAT IS THE BEST TREATMENT OPTION FOR LYMPHEDEMA

• IS LYMPHEDEMA DISABLING - INABILITY TO WORK AND DISABILITY RECOGNITION 

• INTERNATIONAL AWARENESS CAMPAIGN TO PROMOTE CORRECT TREATMENT FOR LYMPHEDEMA

• ELEPHANTIASIS IS NOT ONLY LYMPHATIC FILARIASIS 

• CAMPAIGN TO PREVENT CHILD ELEPHANTIASIS DUE TO PRIMARY AND SECONDARY LYMPHEDEMA 

• BEWARE OF NEW TERMINOLOGY DESCRIBING LYMPHEDEMA TREATMENT

• WHAT KIND OF DOCTOR TREATS LYMPHEDEMA/LYMPHOEDEMA - WHICH MEDICAL SPECIALITIES ARE RELATED TO LYMPHEDEMA

• FAST TRACK SOCIAL SECURITY DISABILITY RECOGNITION FOR CHILDREN WITH LYMPHEDEMA

• INTERMITTENT PNEUMATIC COMPRESSION (IPC) PUMP DEVICES. SERIOUS SIDE EFFECTS POR LYMPHEDEMA

• BEST PRACTICE PROTOCOL GUIDE FOR LYMPHOEDEMA (in Galician)

• A LYMPHEDEMA STORY - DOCTOR KENNETH GERSHENGORN AND THE MAUREEN DIGAN CLINICAL CASE

• WHY IS A BUTTERFLY THE SYMBOL FOR LYMPHEDEMA

• LYMPHEDEMA - INTERNATIONAL DISEASE CODING AND CLASSIFICATION

• WHAT DOES INTERMITTENT PNEUMATIC COMPRESSION PUMP THERAPY (IPC) DO, AND DOES NOT DO FOR LYMPHEDEMA. 

• WHAT IS PHLEBOLYMPHEDEMA.

• IS LYMPHEDEMA PAINFUL?

• WHICH COUNTRY PROVIDES THE BEST LYMPHOEDEMA TREATMENT COVERAGE 

• WHAT IS THE BEST TREATMENT OPTION FOR PAEDIATRIC AND PRIMARY LYMPHOEDEMA

• SPANISH LYMPHEDEMA ASSOCIATIONS – SPANISH NATIONAL FEDERATION OF LYMPHEDEMA ASSOCIATIONS

LYMPHEDEMA INCIDENCE 
AND PREVALENCE
(click on the texts)