March is recognized as Lymphedema Awareness Month, which includes both Primary Lymphedema (a genetic condition) and Secondary Lymphedema (caused by various factors like surgery, radiation, infection, insects, barefoot exposure to irritant soils, etc). Podoconiosis is thus a Secondary Lymphedema, and its most advanced stage is known as "Elephantiasis". The elephantiasis stage (advanced lymphedema) is not something that is only related to podoconiosis or filariasis, or localized in poor and developing counties, but is also related to all the other causes of lymphedema, and can also be found in European and high-tech nations. Read about the myths and facts of elephantiasis HERE.
Podoconiosis (Lymphostatic elephantiasis) is a Secondary Lymphedema caused by long-term barefoot exposure to irritant alkaline volcanic clay soils. The medical term Podoconiosis, or “Mossy Foot Disease” is used to identify a part of the body, principally feet and toes, which has undergone progressive deformity and trophic skin changes due to chronic lymphatic dysfunction. Throughout the world, the lack of treatment or under-treatment of lymphedema, makes advanced lymphedema “elephantiasis” a condition that is still present today.
Lymphedema is due to impaired lymphatic drainage which causes disease of the skin, characterized by persistent and progressive swelling, and abnormal thickening of the skin and underlying connective tissue. Lymphedema is not just a localized swelling problem, but a condition that can affect multiple systems and body structures and functions, leading to a range of physical, physiological and psychosocial symptoms and complications.
Lymphedema (Organic Lymphatic Vascular Disease) 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 implementation 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, 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 fails 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 specialized lymphatic therapy and compression garments in controlling the progression of lymphedema. Clinical results of interventions to control lymphoedema show that simple hygiene-based measures (skincare, exercises, elevation of affected limbs, simple bandages, and use of footwear) are necessary, but these alone are not enough for proper care of the affected extremities.
For the maintenance phase of lymphedema management, compression is the most important intervention. Compression garments (Orthotic Devices) 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.
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 be a substitute for the adequate and necessary clinical treatment that a disease requires.
Compression alone without Manual Lymphatic Drainage (MLD) for the Initial Reduction Phase, 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 LYMPHATIC FILARIASIS AND PODOCONIOSIS?
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 that "Compression Garments" are essential. Infectious cellulitis can lead to sepsis (Septicemia). Read more about the risk of Infectious Cellulitis for Lymphoedema HERE.
