WHAT ARE THE RECOMMENDATIONS AND PREVENTIVE MEASURES TO REDUCE DERMATOLYMPHANGIOADENITIS (DLA) AND ADENOLYMPHANGITIS (ADL) IN LYMPHEDEMA - What are the side effects of taking antibiotics long-term - Pediatric and Primary lymphedema - Secondary Lymphedema - Lymphatic Filariasis and Podoconiosis - lymphoestatic Elephantiasis - Rare Disease

Dermatolymphangioadenitis (also called infectious cellulitis) is an infection of the deep layers of the skin, and erysipela is an infection of the upper layers. Both infections can also overlap. Adenolymphangitis is an inflammatory condition involving lymph nodes (adenitis) and/or lymph vessels (lymphangitis). 

In Lymphatic Vascular Disease, the "best available recommendation" to prevent repeated episodes of dermatolymphangioadenitis (DLA) and adenolymphangitis (ADL), is to improve skin health by reducing and stabilizing the limb volume and circumference of the lymphadematous limb. Early conservative treatment of oedema is necessary for skin integrity, and thus to prevent systemic bacterial inflammatory responses, and further lymphatic damage and dysfunction.

The principle aim of lymphedema treatment is the same for Primary Lymphedema, as well as for all Secondary lymphoedema whatever the cause or setting. All Primary Lymphedema and Secondary Lymphedema like Cancer-related (CR-LE) and filariasis-related lymphedema (FR-LE), basically represent the same chronic disease, and need exactly the same treatment and best practice clinical guidelines. 

The "Gold Standard" treatment for lymphedema, consisting of Complete Decongestive Therapy (CDT) and the use of compression garments, is recommended to help stop and reverse oedema circumference and volume formation, and also to help reduce the incidence rate of hospitalization for the management of recurrent complications like cellulitis and lymphangitis. Effective management of chronic lymphedema improves the physical condition of a person’s skin, which plays a central role in predisposition to complications. Read more about what is the best treatment for lymphedema here.

Reducing the "predisposing conditions" by means of basic self-care, consisting of dermis hygiene and hydration (to avoid fungal infections and dry and cracked skin), and simultaneously reducing the oedematous limb by means of physical therapy and compression garments, is agreed as best practice for the management of lymphedema (ISL International Consensus Document).

There are studies state that the protective effects of antibiotics do not last after prophylaxis has been stopped, and also that taking them too often may lead to a dangerous rise in bacteria that no longer respond to medicine. Antibiotic resistant infections can lead to longer hospital stays, higher treatment costs, and more deaths due to bacteremia (bacteria present in the bloodstream). 

Bacteriemia can progress to systemic inflammatory response syndrome (SIRS), "Sepsis" (septicemia), septic shock, and multiple organ dysfunction syndrome (MODS). On the other hand there are select situations and certain severe infections, that 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.

Many Vascular Surgeons and dermatologist specialized in lymphatic vascular disease agree, that treating the underlying risk factors is the most effective approach for the "prevention" of recurrent infectious cellulitis (dermatolymphangioadenitis) and adenolymphangitis. This in comparison to no reduction and compression treatment for lymphatic oedema, and having to prescribe a continual use of antibiotics due to the progressive swelling, inflammation and it´s consequent severe infectuous complications. 

REFERENCES:

A brief multi-disciplinary review on antimicrobial resistance in medicine and its linkage to the global environmental microbiota
https://www.ncbi.nlm.nih.gov/pubmed/23675371?dopt=Abstract

Using medication: Using antibiotics correctly and avoiding resistance
https://www.ncbi.nlm.nih.gov/books/NBK361005/

Effects of Long Term Antibiotic Therapy on Human Oral and Fecal Viromes.

https://www.ncbi.nlm.nih.gov/pubmed/26309137?dopt=Abstract

Resistance to antibiotics: are we in the post-antibiotic era?

https://www.ncbi.nlm.nih.gov/pubmed/16216651?dopt=Abstract

Erysipelas and lymphedema

https://www.phlebolymphology.org/erysipelas-and-lymphedema/

Consensus Document on the Management of Cellulitis in Lymphoedema. British Lymphology Society (BLS) 

https://www.lymphoedema.org/images/pdf/CellulitisConsensus.pdf

Towards a better understanding of lymph circulation

https://www.phlebolymphology.org/towards-a-better-understanding-of-lymph-circulation/

Diagnosis and management of lymphatic vascular disease

https://www.ncbi.nlm.nih.gov/pubmed/18755341

Effects of Complete Decongestive Therapy on the Incidence of  Cellulitis

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4616085/

Consesus Document of the International Society of Lymphology (ISL)

https://www.internationalsocietyoflymphology.org/wp-content/uploads/2017/12/20106-35060-1-PB.pdf

Conservative Treatment of Lymphoedema. Ethel Földi, M. Földi, H. Weissleder

https://journals.sagepub.com/doi/10.1177/000331978503600306

Foldi E. Prevention of dermatolymphangioadenitis by combined physiotherapy of the swollen arm after treatment for breast cancer. Lymphology. 1996;29:48-49.

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