martes, 14 de junio de 2022

WHAT IS THE CURRENT MANAGEMENT PERSPECTIVE AND SITUATION OF LYMPHATIC FILARIASIS & PODOCONIOSIS? - Lymphostatic Elephantiasis - Primary/Secondary Lymphedema – Best First Line Treatment – Complete Decongestive Therapy (CDT)


Lymphostatic elephantiasis (Stage III lymphedema) is considered to be one of the main neglected diseases worldwide, but is predominantly seen in areas with poor social conditions and deficient sanitary infrastructure and health care coverage. Many individuals affected in these areas receive incomplete information about the disease and its treatment, sometimes alleging that patients have low cultural and educational levels. For the control or elimination strategies regarding any given disease to be successful, the population involved first needs to be aware and correctly instructed by healthcare professionals and community health agents about the disease and its adequate treatment.


Regarding lymphatic filariasis (this is Secondary lymphedema) communities need to be made aware by healthcare professionals regarding prevention, the good use, benefits, and even the potential adverse reactions of medication, and also need to be educated about the benefits of correct safe compression treatment regarding chronic lymphedema.

 

In endemic areas, popular awareness of clinical LF is common with regard to its chronic forms (i.e. swelling of limbs and genitalia), however, most people are unaware or have not been informed of the important role of daily compression in preventing the advance of the disease. Incomplete information and treatment will not help to improve the present situation or achieve the goal of eliminating the elephantiasis stage worldwide.



Patient compliance or non-compliance regarding treatment options, many times goes hand in hand and is directly related to treatment options and results. With reference to low-cost management strategies without the inclusion of the necessary compression garments for the prevention and treatment of stage elephantiasis, little or nothing can be expected with regard to the reduction and maintenance of edema volume. 


Without compression garments, simple hygiene measures such as the washing of limbs will not halt the edema progression, and limb elevation is only effective in early-stage lymphedema according to the ISL(International Society of Lymphology). Likewise, with regard to podoconiosis, the isolated use of footwear without compression garments will not halt the progression of the disease in terms of the consequently established lymphatic dysfunction.

 

On the other hand, it should be assumed that the majority of individuals affected by lymphedema cannot devote all hours of the day to exercise and limb elevation to retain the progression of edema, for they also need to attend to their daily chores and jobs, and this can only be achieved by wearing compression garments. The daily use of standard bandages is not practical, for they tend to loosen and slip off when undertaking work that requires continuous physical activity, and likewise, soiled bandages can also be an important source of infection. 


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.



National health systems should contribute to educational campaigns and strategies for drug distribution to prevent filariasis, but also increase the economic investment for the coverage of clinical care and compression garments for established lymphatic dysfunction, thus optimizing health-related actions and resources in the long run. Without improved healthcare coverage, the frequency of individuals exhibiting chronic manifestations of the elephantiasis stage will continue to increase worldwide.



IMPORTANT NOTICE 

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 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

PATHOPHYSIOLOGY

CUTANEOUS COMPLICATIONS
INFECTIOUS COMPLICATIONS
CELLULITIS / DERMATOLYMPHANGIOADENITIS
TUMOURS

TREATMENT

COMPRESSION GARMENTS

DISABILITY

DISFIGUREMENT

PSYCHOSOCIAL IMPACT

PEDIATRIC LYMPHEDEMA

LYMPHATIC FILARIASIS / PODOCONIOSIS



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