viernes, 17 de enero de 2020

WORLD NEGLECTED TROPICLA DISEASES DAY 2020 - Lymphostatic Elephantiasis - Lymphatic Filariasis & Podoconiosis - Secondary Lymphoedema


January 30 is recognized worldwide, as the day to highlight Neglected Diseases. Some severe and neglected diseases are not only located in poor or developing countries but also can be found in European and high-tech western nations, as is the case of Lymphostatic Elephantiasis. The medical term elephantiasis is used to identify a part of the body, which has undergone progressive deformity and trophic skin changes as a result of chronic lymphedema. Throughout the world, the lack of treatment or under-treatment of lymphedema makes elephantiasis a condition that is still present today.

Elephantiasis is one of the world's most disfiguring, disabling, and life-threatening conditions. Worldwide millions of people suffer from lymphatic dysfunction, be it due to Primary Lymphoedema or Secondary Lymphoedema due to filariasis, podoconiosis, chronic venous insufficiency, cancer, trauma, radiation, infection, surgery, etc. Elephantiasis (final Stage III lymphoedema) can be found in all countries and settings and is nearly always the result of non-treatment or undertreatment of incipient lymphatic edema. Read about why the world is not treating a treatable disease like elephantiasis here.

Lymphedema (elephantiasis) is not a rare disease but a major public health problem, and it is necessary to sensitize governments and international health organizations, that access to treatment for lymphedema and lymphatic diseases should be a global priority. Up to 10 million Americans may be affected by lymphoedema, and it's estimated that over 250 million people worldwide suffer from the disease, creating pain, swelling, discomfort, disability, and suffering for patients of all ages, including children. The only way to avoid elephantiasis (final stage III lymphedema) is to provide early and preventive therapy and compression garments necessary for lymphatic disorders. 

Elephantiasis is preventable in the majority of cases, if the underlying cause which is lymphoedema, is treated in its initial mild stages. In the case of lymphatic filariasis (LF) it is recognized that in many cases it is first acquired in childhood, often as many as one-third of children are infected before age 5. This fact needs urgent implications by international health organizations and public health systems, for prevention campaigns and management for this childhood illness. The cornerstone for the PREVENTION of elephantiasis is compression treatment of initial mild stage I lymphedema, as well as to reduce the incidence of dermato-lymphangio-adenitis (infectious cellulitis) and Lymphangitis, which are the cause of the subsequent worsening of the condition. Read more about DLA (Dermatolymphangioadenitis) in lymphedema here.

There is a safe and effective treatment for lymphatic edema, which helps to retain and maintain the progression of the disease toward its severe late stages. The best treatment for lymphoedema is CDT (Complete Decongestive Therapy), it is considered the “Gold Standard” conservative treatment for the reduction of limb volume. This specialized treatment consists of MLD (Manual Lymphatic Drainage) and Multi-layered bandage wrapping conducted by specialized physiotherapists, as well as other components such as skincare, diet, and exercises. Read more about the best treatment for elephantiasis here.

The Conservative Treatment is indicated for all edema stages including stage III, and as a preventive treatment which will avoid the initial progression toward elephantiasis. Radical reductive ablative surgery, aimed to remove the diseased skin and subcutaneous tissue, should always be the last option, for it is associated with significant blood loss, morbidity, infections, permanent disfigurement, and recurrence of symptoms. 

Apart from the patient daily basic self-care needs, consisting of washing limbs and skin moisturizing, there is also the need to wear compression garments throughout the day. Without compression devices, it is impossible to retain the progression of lymphatic edema. Compression garments are the only means by which a person can carry out their daily activities. Basic self-care alone without compression is not enough by itself to control the disease, and will not stop the progression towards elephantiasis.

International awareness campaigns are needed for access to compression therapy and garments for patients diagnosed with chronic lymphoedema, many of them children, since this is the only possible way to stop the progression of the disease. Elephantiasis is a treatable condition, but it will never be eradicated from the world and will continue to be a severe public health problem, as long as there is non-treatment or under-treatment of lymphatic dysfunction (Lymphedema).


Lymphedema is a serious chronic and progressive disease due to an organic disability. 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 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.


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