domingo, 1 de mayo de 2022

WHAT IS ELEPHANTIASIS? - WHAT IS THE DIFFERENCE BETWEEN ELEPHANTIASIS AND LYMPHATIC FILARIASIS/PODOCONIOSIS? - Myths & Truths - Prevention - Clinical Recommendations - Best First-line Treatment - Primary Lymphedema - Secondary Lymphedema

Some international health organizations portray lymphatic filariasis, elephantiasis, or podoconiosis, as if they were unrelated diseases. Lymphatic filariasis, which is commonly but erroneously known as elephantiasis, is a mosquito-transmitted disease that occurs when filarial parasites (roundworms) damage the lymphatic system causing lymphatic dysfunction (lymphedema). Podoconiosis is a non-filarial, noninfective disease, usually caused by crystalline minerals clogging regional lymph nodes and vessels, affecting especially agrarian people who work barefoot, particularly in the neighborhood of volcanic soil.  These two conditions develop chronic lymphatic dysfunction (lymphedema), and in many cases is acquired in childhoodRead more about childhood elephantiasis prevention HERE.


The medical term Elephantiasis represents lymphedema (whatever cause or setting) in its most advanced degree of severity. There are some organizations and clinical guides that make reference to lymphedema and elephantiasis as if they were two different and isolated conditions, referring to them as lymphedema "or" elephantiasis, which can give rise to confusion. Lymphedema and elephantiasis should not be portrayed as if two different conditions, for they are the same disease and consequence of one another, first comes initial mild lymphedema, and then the late severe stage called elephantiasis, and which is principally due to nontreatment or undertreatmentRead more about the best treatment option for elephantiasis HERE.

Elephantiasis (Stage III lymphedema) is a public health problem and represents the worst disfiguring visible manifestations of the disease, which causes not only physical disability and financial hardship, but also social stigma and isolation due to the disfigurement, and thus loss of Quality of Life (QoL). Regarding Filariasis, it is important to prevent the spreading of the disease, but just as much to prevent unnecessary suffering to individuals that already have established disorders of the lymphatic circulation. Read about why the world is not treating a treatable disease like elephantiasis HERE.


Lymphedema is a symptom of lymphatic failure and manifests as chronic connective tissue disease. Fluids, cells, and proteins usually removed by lymphatic pumping accumulate in the tissue spaces between the skin and underlying muscle, and over time chronic inflammatory processes change the tissue composition and architecture. Early fluid-rich stages are followed by fibrosis and fatty deposits in the middle stages, and advanced stages are marked by hyperkeratosis, papillomatosis, and other skin diseases. Lymphedema, whatever the cause, is incurable and requires life-long care, and effective lymphedema management to gain and improve "Quality of Life" (QoL). 

Lymphedema in its advanced form, known as elephantiasis, is a significant cause of disability, disfigurement, and morbidity, and is principally due to nontreatment or undertreatment.


Two distinct fluids move through and form part of the circulatory system: blood and lymph. The blood system carries oxygen and nutrients to the body's cells and carries hormones, antibodies, and waste materials away. The lymphatic system serves as a defense system for the body, filtering out organisms that cause disease, producing white blood cells, generating antibodies, and supporting the circulatory system by draining excess fluids and proteins from tissues back into the bloodstream. Although they are totally different hemodynamic mechanisms, they are mutually dependent and complementary circulation systems.

Like most other clinical conditions, diseases of the circulatory system like Chronic Venous Insufficiency (CVI) in "Peripheral Vascular Disease", and Lymphedema (LE) in "Lymphatic Vascular Disease", is most treatable in their earliest stages. The goals of preventive treatment in diseases of the blood vascular system, are to reduce the pooling of blood in venous disease, and the goals of preventive treatment in diseases of the lymphatic vascular system, are to reduce the pooling of lymph fluid (dermal backflow) in lymphatic disease, thus preventing limb swelling, skin complications, and disease progression.

Evidence-based research provides the basis for sound clinical practice guidelines and recommendations for diseases of the circulatory system. Vascular medicine or vascular surgery specialists recommend a combination of preventive treatments for people with venous and lymphatic dysfunction. Some of the simple basic daily self-care preventive treatment strategies include:

  • Avoid long periods of standing or sitting.
  • Exercise regularly.
  • Control weight.
  • Elevate limbs while sitting and lying down.
  • Wear compression garments all day.
  • Take antibiotics as needed to treat skin infections.
  • Practice good hygiene and skincare.
  • Use adequate clothing and footwear.


Treatment for lymphedema is an evidence-based clinical need, that centers around reducing the edema which then influences all of the other problems. Education and improving access to health services are keys to the successful prevention of stage elephantiasis. The First-line non-surgical treatment for patients with established lymphedema is Complete Decongestive Therapy (CDT)Treatment is to control the clinical severity and progression of the disease

Scientific studies highlight the importance and implications of compression therapy in controlling the progression of Lymphoedema, and evidence also supports that compression garments are essential. On the other hand, clinical outcomes on interventions to manage lymphedema, show that simple hygiene-based measures (washing and elevation of limbs, antifungal creams, exercise, and use of footwear) are necessary, but these alone without compression therapy, are not enough to reduce the limb volume in the majority of cases. People with lymphedema need access to continuing care throughout their lives, both to manage the disease and to prevent progression to more advanced stages.

If the conservative therapy does not respond,
when applied correctly and conducted by specialized therapists, then microsurgery could be the next option for selected cases. Regarding genital lymphedema (including hydrocele), early lymphedema symptoms (edema) should be treated as soon as possible to reduce the necessity of surgery. 

Radical reductive ablative surgery (Charles Procedure), aimed to remove the diseased skin and subcutaneous tissue in limbs with Stage elephantiasis, should always be the last option, for it is frequently associated with significant blood loss, morbidity, infections, permanent disfigurement, and recurrence of symptoms. Complete Decongestive Therapy (CDT) is not limited to lymphoedema stages 0 and I, and even late Stage III lymphoedema (elephantiasis) improves greatly with good results in the majority of cases, thus preventing the need for debulking techniques. See the video of the treatment of elephantiasis HERE.

With regard to dermatolymphangioadenitis (DLA), also known as "Infectious Cellulitis", studies have found that the control of swelling is associated with a lower risk of cellulitis and that advanced stages of chronic edema are a strong risk factor. Infectious cellulitis can lead to sepsis (septicemia). Read more about what are the preventive measures for Infectious Cellulitis in lymphedema HERE.

The psychological stress factors in lymphedema must also be taken into consideration regarding the "Quality of Life" (QoL) indicators of individuals. Lymphedema is not in itself a psychopathology, nor does it predispose individuals to poor mental health. In many cases, the negative situation of non-treatment or under-treatment of lymphedema leads to increased disease progression and, contributes to the cycle of disability, disfigurement, social stigmatization, poverty, suffering, and thus, the associated burden on the physical, economic, social, and psychological well-being of individuals. Read more information about psychological aspects surrounding the non-treatment of lymphedema HERE.


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.


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