Interdigital skin lesions of the lower limbs among patients with lymphoedema in an area endemic for bancroftian filariasis

Abstract

Summaryobjectives An estimated 15 million persons suffer from lymphoedema of the leg in filariasis-endemic areas of the world. A major factor in the progression of lymphoedema severity is the incidence of acute dermatolymphangioadenitis (ADLA), which is triggered by bacteria that gain entry through damaged skin, especially in the toe web spaces ('interdigital skin lesions'). Little is known about the epidemiology of these skin lesions or about patients' awareness of them.methods We interviewed and examined 119 patients (89% women) with lymphoedema of the leg in Recife, Brazil, an area endemic for bancroftian filariasis.results We detected 412 interdigital skin lesions in 115 (96.6%) patients (mean, 3.5 lesions per patient, range 0-8). The number of interdigital skin lesions was significantly associated with lymphoedema stage (P < 0.001) and frequency of ADLA (P < 0.0001). Only 20 (16.8%) patients detected their own interdigital skin lesions or considered them abnormal. Patients reported a mean of 3.6 ADLA episodes during the previous 12 months (range, 0-20); reported ADLA incidence was associated with lymphoedema stage (P < 0.0001) and the number of interdigital skin lesions detected by the examining physician (P < 0.0001).conclusions These data suggest that interdigital skin lesions are a significant risk factor for ADLA and that persons with lymphoedema in filariasis-endemic areas are unaware of their presence or importance. Prevention of ADLA through prompt recognition and treatment of interdigital skin lesions will require that patients be taught to identify lesions, especially between the toes and to recognize them as abnormal.

Impact of a Community-Based Lymphedema Management Program on Episodes of Adenolymphangitis (ADLA) and Lymphedema Progression - Odisha State, India

“…Decreased ADLA rates and slowing the advancement of chronic lymphedema have important implications for the social stigma, debilitation, and quality of life impacts seen with LF disease. We have previously reported that patients in the lymphedema management program in Khurda district experienced a significant reduction in disability in every domain of the WHO-DAS II disability assessment score [26].…”

“…Although several studies have found an increased ADLA rate among those with increasing lymphedema stage [6], [13], [23], [25] and among those with inter-digital entry lesions [23], [25], [26], none have found an interaction between the disease groups. The decrease in ADLA rate was most striking among patients with advanced lymphedema at baseline and no entry lesions, suggesting the program was most impactful among these patients for decreasing ADLA episodes.…”

Impact of basic lymphedema management and antifilarial treatment on acute dermatolymphangioadenitis episodes and filarial antigenaemia

“…Therefore, training the patients as well as health professionals to deal properly with those potential portals of entry for pathogens became an important part of lymphedema management to reduce the frequency of ADLA attacks, and hence, significantly reducing the morbidity of lymphatic filariasis. [23]…”

Morbidity management in the Global Programme to Eliminate Lymphatic Filariasis: a review of the scientific literature

“…However, other studies – all of which relied on patient recall of ADLA incidence – found no such association [39,40,44,45]. Data from Brazil, India, and Guyana indicate that the presence [54] and number [50,59] of interdigital skin lesions are remarkably strong risk factors for ADLA.…”