lunes, 23 de septiembre de 2019

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). 

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 Organiz Impairment HERE.

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 with minimum effort, or even suffer varying degrees of disability and severe complications. Read more about lymphedema and disability HERE.

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. 

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 employing physical therapy and compression garments, is agreed as best practice for the management of lymphedema (ISL International Consensus Document).

Regarding non-treatment or 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). Read more about the symptoms and complications of lymphedema HERE.

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, where 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


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.


(Click on the texts to read the research articles)












(click on the texts) 

Print this post