DÍA MUNDIAL DE LA PODOCONIOSIS 2023 - 18 DE MARZO - ENFERMEDAD DEL PIE MUSGOSO - LINFEDEMA CRÓNICO INSTAURADO - Enfermedad Vascular Linfática - Discapacidad Orgánica y Física - Elefantiasis Linfostática - Guía de Mejor Práctica Clínica/Protocolo de Tratamiento - Campaña de Sensibilización

Marzo es el "Mes Mundial de Concienciación sobre las Enfermedades Vasculares Linfáticas", que incluye la Podoconiosis como una enfermedad relacionada con la disfunción linfática. El 18 de marzo tiene como objetivo concienciar sobre esta condición que afecta al Sistema Vascular Linfático, y enseñar a la gente que esta enfermedad es fácilmente tratable hoy en día. La mayoría de casos de podoconiosis que progresan hacia el grado de la elefantiasis, se deben a la falta de tratamiento o al infratratamiento del linfedema.

El Linfedema es una enfermedad desatendida en muchos países, especialmente en las comunidades más pobres del mundo. Al igual que las demás enfermedades crónicas desatendidas, la inaccesibilidad al tratamiento del Linfedema, o la recomendación de soluciones alternativas de bajo coste debido a las políticas de ahorro de algunos sistemas nacionales de salud, pueden provocar la progresión de la enfermedad hacia su grado más avanzado de severidad denominada “Elefantiasis”. Esto significa para los pacientes el sufrir más desfiguración, discapacidad,  discriminación (estigmatización social), pérdida de ingresos y calidad de vida (CdV), como puede evaluarse con el modelo CIF (La Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud). Lea más sobre el por qué el mundo no está tratando una condición tratable como la elefantiasis AQUÍ.

¿QUE ES LA FILARIASIS LINFÁTICA Y PODOCONIOSIS?

El uso de calzado es muy importante para la prevención de la Podoconiosis, pero una vez establecida la disfunción linfática crónica (linfedema), el calzado por sí solo no es suficiente para detener la progresión de la enfermedad. Los estudios científicos destacan la importancia de la terapia de compresión en el control de la progresión del linfedema. Los resultados clínicos de las intervenciones para controlar el linfedema muestran que es necesario adoptar medidas higiénicas sencillas (cuidados de la piel, ejercicio, elevación de los miembros afectados y uso de calzado), pero que éstas no bastan por sí solas para reducir el volumen y tamaño de las extremidades. Lea cuales son las VERDADES y los MITOS sobre la elefantiasis y su tratamiento AQUÍ.

Para la fase de mantenimiento del tratamiento del linfedema, las prendas de compresión son la intervención más importante. Las prendas de compresión son fáciles de usar y consiguen mejoras significativas en la mayoría de los pacientes sin causar muchas molestias. El valor del coste-beneficio de la aplicación de medias de compresión en el tratamiento de la enfermedad venosa y linfática está respaldado por recomendaciones calificadas como evidencia de Grado 1. 

El uso diario de vendajes estándar para el linfedema no son prácticos, ya que tienden a aflojarse y deslizarse cuando se realizan trabajos que requieren una actividad física continua, y además, los vendajes sucios también pueden ser una fuente importante de infecciones. 

 

Las estrategias de autogestión según el modelo de atención al paciente con enfermedades crónicas, donde los pacientes deben asumir un papel protagonista en su tratamiento para mejorar el estado de salud, el funcionamiento cotidiano y la calidad de vida, no deberían ni pueden ser, un sustituto del adecuado y necesario tratamiento clínico que requiere una enfermedad.

La compresión por sí sola, sin Drenaje Linfático Manual (DLM) para la Fase I de Reducción Inicial, puede provocar el desplazamiento de la linfa a otras zonas previamente no afectadas, y en el caso de miembros inferiores puede causar Edema Genital. Las personas con linfedema necesitan tener acceso a una atención especializada a lo largo de su vida, tanto para controlar la enfermedad, como para prevenir la progresión a grados más avanzados como la elefantiasis. Lea más información sobre cuáles son las principales funciones del Drenaje Linfático Manual AQUÍ.

QUE ES LA ELEFANTIASIS - MITOS Y REALIDADES

El linfedema de las extremidades y los genitales deben tratarse siempre en sus primeros estadios, y no dejarse sin tratar hasta alcanzar el Grado III (elefantiasis) y luego recurriendo a cirugías agresivas. La cirugía de escisión radical (Técnica de Charles), dirigida a eliminar la piel comprometida y el tejido subcutáneo en el Grado de elefantiasis, siempre debe ser la última opción, ya que con frecuencia está asociada a una pérdida significativa de sangre, morbilidad, infecciones, desfiguración permanente y recurrencia de los síntomas. Lea más sobre cuál es el mejor tratamiento para la Elefantiasis AQUÍ.

En relación con la “Dermatolinfangioadenitis” (DLA), también conocida como celulitis infecciosa, estudios han demostrado que el control de la hinchazón se asocia a un menor riesgo de celulitis, que los Grados avanzados del edema crónico son un fuerte factor de riesgo y asimismo que las “Prendas de Compresión” son esenciales. La Celulitis Infecciosa puede derivar en sepsis (Septicemia). Lea más sobre cuál es el riesgo de la Celulitis Infecciosa para el Linfedema AQUÍ.

La Asamblea General de las Naciones Unidas aprobó una resolución en la que instaba a los países a aspirar al objetivo de que todas las personas, en todas partes, tengan acceso a una atención sanitaria de calidad, y proclamó el 12 de diciembre Día de la Cobertura Sanitaria Universal (Día de la CSU) mediante la resolución 72/138. Millones de personas en todo el mundo están sufriendo de no tratamiento o infratratamiento de linfedema , y siguen esperando una atención sanitaria correcta y eficaz, y muchas de ellas ya se encuentran en fases muy graves (Elefantiasis).

AVISO IMPORTANTE 

El Linfedema es una enfermedad crónica y progresiva debido a una discapacidad orgánica. El tratamiento clínico del linfedema no es ni un tratamiento cosmético ni estético. El tratamiento del linfedema es para controlar su avance y aliviar los síntomas relacionados con la disfunción del sistema circulatorio linfático. 

Para prevenir y evitar problemas graves asociados al tratamiento, como el posible desplazamiento del edema a zonas previamente no afectadas cuando se aplica la terapia de compresión para la reducción del volumen, los pacientes deben recurrir a terapeutas altamente especializados con experiencia. 

La cualificación profesional y la instrucción impartida a distancia en línea no son lo mismo que la instrucción práctica en directo en la formación clínica y la certificación de los terapeutas del linfedema, similar a todos los demás programas de formación en rehabilitación, medicina y cirugía, y especialmente para desarrollar las habilidades manuales necesarias para tratar una enfermedad tan compleja como el linfedema.

Los pacientes deben igualmente tener un especial cuidado a la hora de elegir un "Centro Multidisciplinar de Referencia de Linfedema", ya que no todos los países o centros de referencia proporcionan las mismas opciones de tratamiento. La mejor elección es un centro de referencia que aplica la Terapia Descongestiva Compleja (TDC), que está reconocida como el tratamiento "Estándar de Excelencia" para el linfedema.

• Lea más sobre cual es la mejor opción de tratamiento para Linfedema AQUÍ.

• Lea sobre cuales son las principales funciones del Drenaje Linfático Manual AQUÍ.

• Lea sobre cuales son las importantes diferencias entre los dos principales protocolos de tratamiento para Linfedema AQUÍ. 

• Lea sobre cuales son las estrategias para la aplicación de tratamientos de bajo coste para el linfedema AQUÍ.  

REFERENCIAS

(Pincha sobre los textos para leér los artículos científicos)

SOCIEDADES CIENTÍFICAS

• German Scientific Society Guideline: Diagnostics and Therapy of Lymphoedema.

FISIOPATOLOGÍA

• lymphedema.
• Biology of Lymphedema
• Lymph vessels: the forgotten second circulation in health and disease
• Lymphatic Vessel Network Structure and Physiology
• Lymphatic System Flows
• Organ-specific lymphatic vasculature: From development to pathophysiology.
• The lymphatic vascular system: much more than just a sewer.
• The unresolved pathophysiology of lymphedema.
• Lymphedema: A Practical Approach and Clinical Update.
• Coagulation in Lymphatic System.
• Regulation of immune function by the lymphatic system in lymphedema.
• Oxidative stress in chronic lymphoedema.
• Regulatory T Cells Mediate Local Immunosuppression in Lymphedema.
• Hemostatic properties of the lymph: relationships with occlusion and thrombosis.
• Secondary lymphedema: Pathogenesis
• Gastrointestinal Lymphatics in Health and Disease
• Intestinal lymphangiectasia in adults
• Role of the lymphatic vasculature in cardiovascular medicine
• The lymphatic vasculature in disease
• Lymphoscintigraphic abnormalities in the contralateral lower limbs of patients with unilateral lymphedema.
• The Prevalence of Lower Limb and Genital Lymphedema after Prostate Cancer Treatment: A Systematic Review
• Peripheral Edema

COMPLICACIONES CUTÁNEAS

• The lymphatic system and the skin. Classification, clinical aspects, and histology.
• Lymphedema and cutaneous diseases.
• Lymphedema and subclinical lymphostasis (microlymphedema) facilitate cutaneous infection, inflammatory dermatoses, and neoplasia: A locus minoris resistentiae.
• Serum Immune Proteins in Limb Lymphedema Reflecting Tissue Processes Caused by Lymph Stasis and Chronic Dermato-lymphangio-adenitis (Cellulitis).
• Lymphedema and subclinical lymphostasis (microlymphedema) facilitate cutaneous infection, inflammatory dermatoses, and neoplasia: A locus minoris resistentiae.

COMPLICACIONES INFECCIOSAS

• Lymphatic Flow: A Potential Target in Sepsis.
• Infectious complications of lymphedema.
• Acute inflammatory exacerbations in lymphoedema.
• Inflammatory Manifestations of lymphedema.

CELULITIS / DERMATOLINFANGIOADENITIS

• Cellulitis.
• Clinical features, microbiological epidemiology, and recommendations for the management of cellulitis in extremity lymphedema.
• Challenges of cellulitis in a lymphedematous extremity.
• Diagnosis and management of cellulitis.
• Cellulitis risk factors for patients with primary or secondary lymphedema.
• Oedema as a risk factor for multiple episodes of cellulitis/erysipelas of the lower leg.
• Prevention of dermatolymphangioadenitis by combined physiotherapy.
• Erysipelas: a common potentially dangerous infection.

TUMORES

• Malignant tumors as complications of lymphedema.
• Lymphedematous areas: Privileged sites for tumors, infections, and immune disorders.
• Lymphedema-related angiogenic tumors and other malignancies.
• Lymphedema: an immunologically vulnerable site for the development of neoplasms.
• Lymph stasis promotes tumor growth
• A retrospective analysis of Stewart-Treves syndrome in the context of chronic lymphedema.
• Stewart-Treves Syndrome

DOLOR

• Congenital lymphedema complicated by pain and psychological distress: case report
• Lymphatic Pain in Breast Cancer Survivors
• Does Manual Lymphatic Drainage Have Any Effect on Pain Threshold and Tolerance of Different Body Parts?
• Lymphedema therapy reduces the volume of edema and pain in patients with breast cancer
• Quality of life in patients with primary and secondary lymphedema in the community

TRATAMIENTO

• Treatment of limbs lymphedema.
• Nonoperative treatment of lymphedema.
• Lymphedema: From diagnosis to treatment.
• Lymphedema-clinical picture and therapy.
• Physiotherapeutic rehabilitation of lymphedema: state-of-the-art.
• Diagnosis and management of lymphatic vascular disease
• Effective treatment of lymphedema of the extremities.
• Lymphoscintigraphic aspects of the effects of manual lymphatic drainage.
• Intensive Treatment of Lower-Limb Lymphedema and Variations in Volume.
• Effectiveness and safety of Complete Decongestive Therapy of Phase I.
• Therapeutic Efficacy of Complex Decongestive Therapy in the Treatment of Elephantiasis of the Lower Extremities.
• Effects of Phase I complex decongestive physiotherapy on physical functions and depression levels in breast cancer-related lymph edema.
• Does lymphoedema bandaging reduce the risk of toe ulceration?
• Study of 700 referrals to a Lymphedema Program.
• Worldwide assessment of healthcare personnel dealing with lymphoedema.
• Földi M, Földi E. Földi’s textbook of lymphology for physicians and Lymphoedema therapists.
• Fluid Shifts Induced by Physical Therapy in Lower Limb Lymphedema Patients
• Visualization of Accessory Lymphatic Pathways, before and after Manual Drainage, in Secondary Upper Limb Lymphedema Using Indocyanine Green Lymphography
• The risk of genital edema after external pump compression for lower limb lymphedema.
• The management of genital lymphoedema
• The management of deep vein thrombosis in lymphoedema: a review.
• Lymphedema-associated comorbidities and treatment gap.

PRENDAS DE COMPRESIÓN

• A study of the advantages of elastic stockings for leg lymphedema.
• Indications for medical compression stockings in venous and lymphatic disorders: An evidence-based consensus statement.
• Medical compression stockings for chronic venous diseases and lymphedema: Scientific evidence and results of a patient survey on quality of care.
• Impact of Compression Therapy on Cellulitis (ICTOC) in adults with chronic edema: a randomized controlled trial protocol.
• Compression Therapy Is Cost-Saving in the Prevention of Lower Limb Recurrent Cellulitis in Patients with Chronic Edema.
• Occupational leg edema-use of compression stockings.

DISCAPACIDAD

• Disability and lymphedema.
• Lymphedema and employability.
• Worse and worse off: the impact of lymphedema on work and career after breast cancer
• Functioning in lymphedema from the patient's perspective using the International Classification of Functioning, Disability and Health (ICF).
• Unilateral upper extremity lymphedema deteriorates the postural stability in breast cancer survivors
• Postural Stability in Patients with Lower Limb Lymphedema
• Disability, psychological distress and quality of life in breast cancer survivors with arm lymphedema

DISFIGURACIÓN

• Adjusting to disfigurement: processes involved in dealing with being visibly different
• Quality of Life in Cancer Patients with Disfigurement due to Cancer and its Treatments
• Quality-of-life and body image impairments in patients with lymphedema
• Association of lower extremity lymphedema with pelvic floor functions, sleep quality, kinesiophobia, body image in patients with gynecological cancers

CALIDAD DE VIDA

• The impact of lower limb chronic oedema on patients' quality of life
• Quality of life in patients with primary and secondary lymphedema in the community
• Evaluating the effect of upper-body morbidity on quality of life following breast cancer treatment.
• Functionality and quality of life of patients with unilateral lymphedema of a lower limb: a cross-sectional study
• The effect of complete decongestive therapy on the quality of life of patients with peripheral lymphedema

IMPACTO PSYCHOSOCIAL

• Psychosocial Impact of Lymphedema.
• Associations between chronic disease, age, and physical and mental health status
• A network analysis of psychological flexibility, coping, and stigma in dermatology patients
• 'Abandoned by medicine'? A qualitative study of women's experiences with lymphoedema secondary to cancer, and the implications for care
• People are neglected, not diseases.
• Chronic edema/lymphoedema: under-recognized and under‐treated.
• Lymphatic Medicine: Paradoxically and unnecessarily ignored.
• Medical education: a deficiency or a disgrace.

LINFEDEMA PEDIÁTRICO

• NORD: Rare Disease Database - Lymphedema
• Medical management of lymphedema.
• Primary lymphedema in childhood.
• An approach to familiar lymphedema
• Pediatric Children Lymphedema
• Primary Lymphedema French National Diagnosis and Care Protocol (PNDS).
• Lymphatic filariasis: an infection of childhood.
• Lymphatic filariasis in children: clinical features, infection burdens and future prospects for elimination.

FILARIASIS / PODOCONIOSIS LINFÁTICA

• Podoconiosis: Clinical spectrum and microscopic presentations.
• Podoconiosis: A Possible Cause of Lymphedema in Micronesia.
• A cross-sectional study to evaluate depression and quality of life among patients with lymphoedema due to podoconiosis, lymphatic filariasis, and leprosy.
• The impact of acute adenolymphangitis in podoconiosis on caregivers.
• Neglected tropical diseases and disability-what is the link?
• Locomotor disability in bancroftian filarial lymphoedema patients.
• Neglected patients with a neglected disease?
• Neglected tropical diseases and mental health: a perspective on comorbidity.
• People are neglected, not diseases.
• Addressing Inequity: Neglected Tropical Diseases and Human Rights.
• Neglected Tropical Diseases, Conflict, and the Right To Health.

SISTEMA VASCULAR SANGUÍNEO 

• Peripheral Edema
• Phlebolymphedema
• Understanding Chronic Venous Disease: A Critical Overview of Its Pathophysiology and Medical Management
• Role of the lymphatic vasculature in cardiovascular medicine
• Communication between lymphatic and venous systems
• Phlebopathies and occupation
• Phlebopathies and workers
• Evidence of health risks associated with prolonged standing at work and intervention effectiveness
• Leg edema formation and venous blood flow velocity during a simulated long-haul flight

WORLD PODOCONIOSIS DAY 2023 - MARCH 18TH - MOSSY FOOT DISEASE - CHRONIC ESTABLISHED LYMPHEDEMA - Organic and Physical Disability - Lymphatic Vascular Disease - Secondary Lymphedema - Best Practices Management Guideline / Treatment Protocol / Patient Care Pathway - Awareness Campaign

March is "World Lymphatic Vascular Disease Awareness Month" which includes Podoconiosis as a disease related to Lymphatic dysfunction. March 18th aims to raise awareness about podoconiosis, a disease that affects the Lymphatic Vascular System, and teach people that this disease is easily treatable nowadays. The majority of cases of podoconiosis that progress to the elephantiasis stage are due to a lack of treatment or undertreatment of lymphedema. 

Lymphoedema is a neglected disease in many countries, especially in the world's poorest communities. Like other neglected chronic diseases, inaccessibility to the treatment of lymphedema, or the recommendation of low-cost alternative solutions due to the cost-saving policies of some national health systems, can lead to the progression of the disease to its most advanced degree of severity called "Elephantiasis". For patients, this means further disfigurement, disability, discrimination (Social Stigmatization), loss of income, and loss of quality of life (QoL) as can be assessed with the ICF model (International Classification of Functioning, Disability, and Health). Read more about why the world is failing to treat a treatable condition like elephantiasis HERE.

WHAT IS LYMPHATIC FILARIASIS AND PODOCONIOSIS?

The use of footwear is very important for the prevention of Podoconiosis, but once chronic lymphatic dysfunction (lymphedema) is established, shoes alone are not enough to stop the progression of the disease. Scientific studies highlight the importance of compression therapy in controlling the progression of lymphedema. Clinical results of interventions to control lymphoedema show that simple hygiene-based measures (skin care, exercises, elevation of affected limbs, and use of footwear) are necessary, but these alone are not enough to reduce the volume and size of the extremities. Read about what are the TRUTHS and MITHS about Elephantiasis and its treatment HERE.

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 for lymphedema is not practical, for they tend to loosen and slip off when undertaking work that requires continuous physical activity, and likewise, dirty bandages can also be an important source of infection.

Self-management strategies according to the chronic care model (CCM), where patients with chronic diseases should assume a leading role in their treatment to improve health status, daily functioning, and quality of life, should not and cannot be, a substitute for the proper and necessary clinical treatment that a disease requires.

Compression alone without Manual Lymphatic Drainage (MLD) for the Initial Reduction Phase I, can cause displacement of lymph to other previously non-affected areas, which in the case of lower limbs can cause Genital Edema. People with lymphedema need access to specialized care throughout their lives, both to manage the disease and to prevent progression to more advanced stages such as elephantiasis. Read more about the principal functions of Manual Lymphatic Drainage HERE.

WHAT IS ELEPHANTIASIS - MYTHS AND FACTS

Lymphedema of the limbs and genitalia should always be treated in its early stages, and not left untreated until they reach Stage III (elephantiasis), and then resorting to aggressive surgeries. Radical reductive ablative surgery (Charles Procedure), aimed to remove the diseased skin and 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. Read more about the best treatment for Elephantiasis HERE.

Concerning “Dermatolymphangioadenitis” (DLA), also known as infectious cellulitis, studies have shown that swelling control is associated with a lower risk of cellulitis, that advanced degrees of chronic edema are a strong risk factor, and also that "Compression Garments" are essential. Infectious Cellulitis can lead to sepsis (septicemia). Read more about the risk of Infectious Cellulitis for Lymphoedema HERE.

The United Nations General Assembly endorsed a resolution urging countries to aim towards the goal that everyone, everywhere, should have access to quality health care, and proclaimed 12 December as Universal Health Coverage Day (UHC Day) by resolution 72/138. Millions of people all over the world are suffering from nontreatment or undertreatment of Lymphedema, and are still waiting for proper and effective health care, and many of them are already in the very severe stages (Elephantiasis). 

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

• German Scientific Society Guideline: Diagnostics and Therapy of Lymphoedema.

PATHOPHYSIOLOGY

• lymphedema.
• Biology of Lymphedema
• Lymph vessels: the forgotten second circulation in health and disease
• Lymphatic Vessel Network Structure and Physiology
• Lymphatic System Flows
• Organ-specific lymphatic vasculature: From development to pathophysiology.
• The lymphatic vascular system: much more than just a sewer.
• The unresolved pathophysiology of lymphedema.
• Lymphedema: A Practical Approach and Clinical Update.
• Coagulation in Lymphatic System.
• Regulation of immune function by the lymphatic system in lymphedema.
• Oxidative stress in chronic lymphoedema.
• Regulatory T Cells Mediate Local Immunosuppression in Lymphedema.
• Hemostatic properties of the lymph: relationships with occlusion and thrombosis.
• Secondary lymphedema: Pathogenesis
• Gastrointestinal Lymphatics in Health and Disease
• Intestinal lymphangiectasia in adults
• Role of the lymphatic vasculature in cardiovascular medicine
• The lymphatic vasculature in disease
• Lymphoscintigraphic abnormalities in the contralateral lower limbs of patients with unilateral lymphedema.
• The Prevalence of Lower Limb and Genital Lymphedema after Prostate Cancer Treatment: A Systematic Review
• Peripheral Edema

CUTANEOUS COMPLICATIONS

• The lymphatic system and the skin. Classification, clinical aspects, and histology.
• Lymphedema and cutaneous diseases.
• Lymphedema and subclinical lymphostasis (microlymphedema) facilitate cutaneous infection, inflammatory dermatoses, and neoplasia: A locus minoris resistentiae.
• Serum Immune Proteins in Limb Lymphedema Reflecting Tissue Processes Caused by Lymph Stasis and Chronic Dermato-lymphangio-adenitis (Cellulitis).
• Lymphedema and subclinical lymphostasis (microlymphedema) facilitate cutaneous infection, inflammatory dermatoses, and neoplasia: A locus minoris resistentiae.

INFECTIOUS COMPLICATIONS

• Lymphatic Flow: A Potential Target in Sepsis.
• Infectious complications of lymphedema.
• Acute inflammatory exacerbations in lymphoedema.
• Inflammatory Manifestations of lymphedema.

CELLULITIS / DERMATOLYMPHANGIOADENITIS

• Cellulitis.
• Clinical features, microbiological epidemiology, and recommendations for the management of cellulitis in extremity lymphedema.
• Challenges of cellulitis in a lymphedematous extremity.
• Diagnosis and management of cellulitis.
• Cellulitis risk factors for patients with primary or secondary lymphedema.
• Oedema as a risk factor for multiple episodes of cellulitis/erysipelas of the lower leg.
• Prevention of dermatolymphangioadenitis by combined physiotherapy.
• Erysipelas: a common potentially dangerous infection.

TUMOURS

• Malignant tumors as complications of lymphedema.
• Lymphedematous areas: Privileged sites for tumors, infections, and immune disorders.
• Lymphedema-related angiogenic tumors and other malignancies.
• Lymphedema: an immunologically vulnerable site for the development of neoplasms.
• Lymph stasis promotes tumor growth
• A retrospective analysis of Stewart-Treves syndrome in the context of chronic lymphedema.
• Stewart-Treves Syndrome

PAIN

• Congenital lymphedema complicated by pain and psychological distress: case report
• Lymphatic Pain in Breast Cancer Survivors
• Does Manual Lymphatic Drainage Have Any Effect on Pain Threshold and Tolerance of Different Body Parts?
• Lymphedema therapy reduces the volume of edema and pain in patients with breast cancer
• Quality of life in patients with primary and secondary lymphedema in the community

TREATMENT

• Treatment of limbs lymphedema.
• Nonoperative treatment of lymphedema.
• Lymphedema: From diagnosis to treatment.
• Lymphedema-clinical picture and therapy.
• Physiotherapeutic rehabilitation of lymphedema: state-of-the-art.
• Diagnosis and management of lymphatic vascular disease
• Effective treatment of lymphedema of the extremities.
• Lymphoscintigraphic aspects of the effects of manual lymphatic drainage.
• Intensive Treatment of Lower-Limb Lymphedema and Variations in Volume.
• Effectiveness and safety of Complete Decongestive Therapy of Phase I.
• Therapeutic Efficacy of Complex Decongestive Therapy in the Treatment of Elephantiasis of the Lower Extremities.
• Effects of Phase I complex decongestive physiotherapy on physical functions and depression levels in breast cancer-related lymph edema.
• Does lymphoedema bandaging reduce the risk of toe ulceration?
• Study of 700 referrals to a Lymphedema Program.
• Worldwide assessment of healthcare personnel dealing with lymphoedema.
• Földi M, Földi E. Földi’s textbook of lymphology for physicians and Lymphoedema therapists.
• Fluid Shifts Induced by Physical Therapy in Lower Limb Lymphedema Patients
• Visualization of Accessory Lymphatic Pathways, before and after Manual Drainage, in Secondary Upper Limb Lymphedema Using Indocyanine Green Lymphography
• The risk of genital edema after external pump compression for lower limb lymphedema.
• The management of genital lymphoedema
• The management of deep vein thrombosis in lymphoedema: a review.
• Lymphedema-associated comorbidities and treatment gap.

COMPRESSION GARMENTS

• A study of the advantages of elastic stockings for leg lymphedema.
• Indications for medical compression stockings in venous and lymphatic disorders: An evidence-based consensus statement.
• Medical compression stockings for chronic venous diseases and lymphedema: Scientific evidence and results of a patient survey on quality of care.
• Impact of Compression Therapy on Cellulitis (ICTOC) in adults with chronic edema: a randomized controlled trial protocol.
• Compression Therapy Is Cost-Saving in the Prevention of Lower Limb Recurrent Cellulitis in Patients with Chronic Edema.
• Occupational leg edema-use of compression stockings.

DISABILITY

• Disability and lymphedema.
• Lymphedema and employability.
• Worse and worse off: the impact of lymphedema on work and career after breast cancer
• Functioning in lymphedema from the patient's perspective using the International Classification of Functioning, Disability and Health (ICF).
• Unilateral upper extremity lymphedema deteriorates the postural stability in breast cancer survivors
• Postural Stability in Patients with Lower Limb Lymphedema
• Disability, psychological distress and quality of life in breast cancer survivors with arm lymphedema

DISFIGUREMENT

• Adjusting to disfigurement: processes involved in dealing with being visibly different
• Quality of Life in Cancer Patients with Disfigurement due to Cancer and its Treatments
• Quality-of-life and body image impairments in patients with lymphedema
• Association of lower extremity lymphedema with pelvic floor functions, sleep quality, kinesiophobia, body image in patients with gynecological cancers

QUALITY OF LIFE

• The impact of lower limb chronic oedema on patients' quality of life
• Quality of life in patients with primary and secondary lymphedema in the community
• Evaluating the effect of upper-body morbidity on quality of life following breast cancer treatment.
• Functionality and quality of life of patients with unilateral lymphedema of a lower limb: a cross-sectional study
• The effect of complete decongestive therapy on the quality of life of patients with peripheral lymphedema

PSYCHOSOCIAL IMPACT

• Psychosocial Impact of Lymphedema.
• Associations between chronic disease, age and physical and mental health status
• A network analysis of psychological flexibility, coping, and stigma in dermatology patients
• 'Abandoned by medicine'? A qualitative study of women's experiences with lymphoedema secondary to cancer, and the implications for care
• People are neglected, not diseases.
• Chronic edema/lymphoedema: under-recognized and under‐treated.
• Lymphatic Medicine: Paradoxically and unnecessarily ignored.
• Medical education: a deficiency or a disgrace.

PEDIATRIC LYMPHEDEMA

• NORD: Rare Disease Database - Lymphedema
• Medical management of lymphedema.
• Primary lymphedema in childhood.
• An approach to familiar lymphedema
• Pediatric Children Lymphedema
• Primary Lymphedema French National Diagnosis and Care Protocol (PNDS).
• Lymphatic filariasis: an infection of childhood.
• Lymphatic filariasis in children: clinical features, infection burdens and future prospects for elimination.

LYMPHATIC FILARIASIS / PODOCONIOSIS

• Podoconiosis: Clinical spectrum and microscopic presentations.
• Podoconiosis: A Possible Cause of Lymphedema in Micronesia.
• A cross-sectional study to evaluate depression and quality of life among patients with lymphoedema due to podoconiosis, lymphatic filariasis, and leprosy.
• The impact of acute adenolymphangitis in podoconiosis on caregivers.
• Neglected tropical diseases and disability-what is the link?
• Locomotor disability in bancroftian filarial lymphoedema patients.
• Neglected patients with a neglected disease?
• Neglected tropical diseases and mental health: a perspective on comorbidity.
• People are neglected, not diseases.
• Addressing Inequity: Neglected Tropical Diseases and Human Rights.
• Neglected Tropical Diseases, Conflict, and the Right To Health.

BLOOD VASCULAR SYSTEM 

• Peripheral Edema
• Phlebolymphedema
• Understanding Chronic Venous Disease: A Critical Overview of Its Pathophysiology and Medical Management
• Role of the lymphatic vasculature in cardiovascular medicine
• Communication between lymphatic and venous systems
• Phlebopathies and occupation
• Phlebopathies and workers
• Evidence of health risks associated with prolonged standing at work and intervention effectiveness
• Leg edema formation and venous blood flow velocity during a simulated long-haul flight