sábado, 19 de marzo de 2022

WORLD ELEPHANTIASIS DAY 2022 - Lymphatic Vascular Disease - Pediatric and Primary Lymphedema - Secondary Lymphedema - Lymphatic Filariasis - Podoconiosis - Mossy Foot - Awareness Campaign


A DAY FOR VINDICATION, MARCH 12, WORLD ELEPHANTIASIS DAY

Despite effective treatment, lymphedema is still one of the world’s most neglected diseases, and people in many countries are shunned and discriminated against. The burden associated with lymphedema Stage III (elephantiasis) affects the physical, psychological, social, and economic well-being of people, contributing to the cycle of disability, disfigurement (body deformities), and social stigmatization, poverty, and suffering.

World Elephantiasis Day is celebrated during Lymphedema Awareness Month, which aims to raise awareness about diseases that affect the Lymphatic Vascular System, and teach people that it is easily treatable today. Lymphedema Stage III (elephantiasis) is not a rare condition, and many people in developing continue to suffer due to a lack of access to basic medical care. 

Like most other clinical conditions, diseases of the circulatory system such as Chronic Venous Insufficiency (CVI) in peripheral vascular disease, and Lymphedema (LE) in lymphatic vascular disease, are more easily treated in their earlier stages. The goals of preventive treatment in diseases of the vascular system, are to reduce the pooling of blood in venous disease, and the pooling of lymph fluid in lymphatic disease, thus preventing limb swelling, skin complications, and disease progression. 

Vascular medicine or vascular surgery specialists typically recommend a combination of preventive treatments for people with venous insufficiency and lymphatic dysfunction. Some of the simple basic daily self-care preventive treatment strategies include avoiding long periods of standing or sitting, exercising regularly, controlling weight, elevating limbs while sitting and lying down, wearing gradient compression garments, taking antibiotics as needed to treat skin infections, practicing good hygiene and skin care, and using adequate clothing and footwear.

Scientific studies highlight the importance and implications of compression therapy in controlling the progression of Lymphoedema. Clinical outcomes on interventions to manage lymphedema show that simple hygiene-based measures (washing and elevation of limbs, exercise, use of footwear) are necessary, but these alone without compression are not enough to reduce the limb size and volume.

Education and improving access to health services are keys to the successful prevention of Lymphedema Stage III (elephantiasis). The first-line strategy for patients with established lymphedema is Complete Decongestive Therapy (CDT). Manual Lymphatic Drainage (MLD) and compression (multilayer low-stretch bandages and gradient compression garments) are the cornerstones of therapy. 

Complete Decongestive Therapy (CDT) is not limited to lymphedema stages 0 and I, and even late Stage III lymphedema (elephantiasis) improves greatly with good results in the majority of cases, with adequate lymphatic therapy and compression garments, thus preventing the need for debulking techniques.

Limb and genital Lymphedema should always be treated in their early stages, and not left undertreated till reaching its severe Stage III – elephantiasis. Radical reductive ablative surgery (Charles Procedure), aimed to remove the subcutaneous tissue in the elephantiasis stage, should always be the last option for it is frequently associated with significant blood loss, morbidity, infections, permanent disfigurement, and recurrence of symptoms. 

For the maintenance phase of lymphedema management, compression is the most important intervention. Compression garments are easy to use and achieve significant improvements in most patients without causing much discomfort. The beneficial value of applying compression stockings in the treatment of venous and lymphatic disease is supported by recommendations rated as Grade 1 evidence. The daily use of standard bandages is not practical, for they tend to loosen and slip off when undertaking work that requires continuous physical activity, and likewise, soiled bandages can also be an important source of infection. Read more information on what is the best treatment for the Elephantiasis Stage HERE.

Due to derangement of lymphatic function and resulting weak body defense, the limb with lymphedema is prone to repeated bacterial and fungal infections. Concerning “Dermatolymphangioadenitis” (DLA), also known as infectious cellulitis, studies have shown that swelling control is associated with a lower risk of cellulitis, and furthermore, that advanced degrees of chronic edema are a strong risk factor. Infectious Cellulitis can lead to sepsis (Septicaemia). Read more about the risk of infectious cellulitis for Lymphoedema HERE. 

Regarding Pediatric lymphedema, it is essential that children diagnosed with lymphatic dysfunction due to filariasis (Lymphatic Filariasis), which is also lymphedema, receive early lymphatic therapy and compression garments with the first signs, to minimize fluid build-up and prevent later life severe clinical complications, disfigurement, and disability. Recent tests have revealed that LF is first acquired in childhood, often with as many as one-third of children infected before age 5. Prevention and controlling early warning signs and symptoms are important since there is no cure.

Lymphedema is a progressive disease, and early diagnosis and treatment are paramount. Therefore, it is critical to diagnose and treat both mild and early onset cases to halt the progression of this lifelong and often debilitating condition. During World Elephantiasis Day, we seek to increase public understanding of Lymphatic Vascular Diseases and tackle the social stigma and undertreatment attached to this treatable disease.

IMPORTANT NOTICE 

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.

REFERENCES

(Click on the texts to read the research articles)

SCIENTIFIC SOCIETIES

PATHOPHYSIOLOGY

CUTANEOUS COMPLICATIONS
INFECTIOUS COMPLICATIONS
CELLULITIS / DERMATOLYMPHANGIOADENITIS
TUMOURS

TREATMENT

COMPRESSION GARMENTS

DISABILITY

DISFIGUREMENT

PSYCHOSOCIAL IMPACT

PEDIATRIC LYMPHEDEMA

LYMPHATIC FILARIASIS / PODOCONIOSIS



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