miércoles, 7 de agosto de 2019

WHAT IS THE RISK OF DERMATOLYMPHANGIOADENITIS-DLA (INFECTIOUS CELLULITIS) IN LYMPHEDEMA - What is the best Preventive Treatment – Pediatric and Primary Lymphedema - Secondary Lymphedema - Lymphatic Filariasis and Podoconiosis - Lymphostatic Elephantiasis - Rare Disease

Dermatolymphangioadenitis-DLAalso known as "Infectious Cellulitis"is a common and serious bacterial infection of the deeper layers of the skin, due to obstructive peripheral lymphedema which deteriorates lymphatic function, and in advanced cases needs hospitalization. The most common clinical manifestations of DLA are fever, headache, pain, inflammation in the affected region, erythema, and vomiting. Infectious cellulitis has a high risk of leading to life-threatening complications such as Sepsis (bacteremia). The recommended treatment for infectious cellulitis is antibiotics.

Lymphedema is a progressive disfiguring and disabling disease of the skin, classified as a functional, immune, and lymphatic circulatory system disorder (Organic Lymphatic Vascular Disease). The lymphatics are an active and integrated component of the immune response, and in lymphedema, there is always an increased susceptibility to infection due to the compromised immune system. Read more about what is an Organiz Disease and Impairment HERE.

It is clear that no patient or their lymphedema is the same and neither is its progress. Some patients with lymphedema have few symptoms, and can easily do different degrees of physical activity, while others feel the strain, experience increased swelling with minimum effort, or even suffer varying degrees of disability and severe complications. Read more about the symptoms and complications of lymphedema HERE.

Episodes of acute ADLA are difficult to halt, especially when lymphatic edema is without adequate compression treatment, even with the intervention of hygiene-based measures and limb elevation care. In the early stages of lymphedema, pitting is clear, the skin is soft, and limb elevation may assist in resolving the edema, but as the disease progresses pitting ceases, the skin hardens, and elevation does not relieve the swelling. 

All lymphedema whatever the cause or setting
including filariasis and podoconiosis, are chronic edema characterized by progressive swelling and inflammation due to lymphatic dysfunction. The best way to control the clinical manifestations is with compressive therapy and garments. Daily washing of the affected limbs with soap and water and the elevation of limbs are important, but "NOT" the central component in the treatment package that this disease needs.

The effectiveness of washing alone interventions will not resolve the majority of cases of morbidity, quality of life of patients, or incidence of acute dermatolymphangioadenitis (cellulitis). Chronic lymphedema without compression treatment and garments, has a high risk and probability of ending up in important infections and consequent life-threatening complications like Sepsis (bacteremia). Read more about what are the recommendations and preventive measures to reduce dermatolymphangioadenitis HERE.

On the other hand, there are select situations and certain severe infections, where antibiotic therapy must be given for a prolonged period of time, and treating the infection outweighs the potential for developing side effects and bacterial resistance.

Lymphedema severity hampers and may not permit
doing many jobs and daily activities, and only with good standard protocols for lymphedema management to reduce limb volume, will this benefit the quality of life and disability incidence. With adequate compression treatment options, overall quality of life increases positively, and disability scores decrease significantly. Read more about Lymphedema and disability HERE.

Click to see the video of the "Best Treatment Option for  Lymphoedema" :

Regarding lymphedema due to Filariasis (Lymphatic Filariasis) and Podoconiosis, the implementation of educational programs for basic self-care and community-based lymphedema management without compression therapy and garments, as the only treatment available, in the majority of cases does not solve the chronic swelling process of mild lymphedema towards Lymphedema Stage III (elephantiasis). On the other hand, the burden of treatment should not be placed solely on the community or Families, for there are important questions concerning the family's time availability, or if they live at far distances. 

It must be stated, that even with basic self-care and community-based programs, the majority of individuals can't perform daily activities and work, without access and the permanent use of compression garments. 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. 

Without an adequate management approach, the majority of lymphatic edema will continue to aggravate towards progressive inflammation, swelling, and major complications. Only with the implementation of adequate lymphedema management programs, will there be a significant decrease in both limb volume and the incidence of infectious cellulitis (dermatolymphangioadenitis-DLA) in lymphatic edema.


Lymphedema is a serious chronic and progressive disease due to lymphatic dysfunction (Organic Lymphatic Vascular Disease). 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 Expert 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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