Risk Factors for Chronic Intertrigo of the Lymphedema Leg in Southern India

Abstract

Rich clinical experiences indicate that toe web intertrigo is a major predisposing condition for cellulitis/acute dermatolymphango adenitis (ADLA) and the number of lesions is the strongest predictor of frequency of ADLA in lymphedema (LE) patients. However, there is scanty information on the risk factors for the establishment of chronic toe web intertrigo in LE patients. We performed a case-control study recruiting 52 lower limb LE with intertrigo and 52 lower limb LE without intertrigo in community settings and assessed general and local potential risk factors for chronic intertrigo. Analysis of local risk factors revealed that topical application of oil, tingling and numbness of the extremities were associated independently with chronic intertrigo. In multivariate analysis, LE grades III and IV were associated with chronic intertrigo, after adjusting for tingling and numbness, prophylactic antibiotic, age group, and gender. From a public health perspective, LE patients of grades III and IV and patients under antibiotic prophylaxis should be self-motivated to look for the early symptoms of toe web intertrigo to prevent chronic stage and recurrent episodes of cellulitis. Patients with history of tingling and numbness of the periphery need to be monitored for pressure effects leading to poor vascularization and delayed healing of intertrigo.

A study on “clinical epidemiology of filarial lymphedema patients attending filariasis clinic in Pondicherry”

“…Filarial patients also endure certain acute manifestations that include Acute Dermato-Lymphangio-Adenitis (ADLA) and Acute Filarial Lymphangitis (AFL) in endemic areas and it has been established by bacteriological and immunological studies that secondary bacterial infections play a major role in ADLA and AFL 3,8,9 ADLA is important cause of suffering and economic loss in filariasis-endemic areas. Fungal infection in toe web space (interdigital skin lesions) are also frequently observed in filarial lymphoedema patient, which could serve as portal of entry for pathogenic bacteria and therefore considered as the major predisposing factor for ADL, 3,10,11 Lymphoedema is transient in early stages and gets established in late second decade of life. With repeated skin infections followed by fibrotic changes, different secondary manifestations such as skin thickening nodule formation and warty growths get established.…”

“…9,10 Though most of the studies report on these major clinical manifestations, the finer details such the proportion of advanced stage 3 and 4 stages, various secondary clinical manifestations, ADLA frequencies in different grades of lymphoedema, intertrigo prevalence and risk factors are not reported from various regions. 10,11 The present study focused on studying the detailed clinical features of filarial lymphedema patient reporting to the exclusive filariasis clinics in Pondicherry. and studying the determinants for clinical staging of the filarial lymphoedema of the https://doi.org/10.1016/j.cegh.2020.02.023 Received 10 January 2019; Received in revised form 4 February 2020; Accepted 24 February 2020 lower extremities.…”