lunes, 13 de marzo de 2023

WORLD PODOCONIOSIS DAY 2023 - MARCH 18TH - 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.

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.

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.

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). 


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.


(Click on the texts to read the research articles)











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