title: Histopathologic improvement with lymphedema management, Léogâne, Haiti.
abstract: In countries where bancroftian filariasis is endemic, lymphedema of the leg is a public health problem, particularly for women, who are disproportionately affected. We investigated the effect of basic lymphedema management (hygiene, skin care, and lower limb movement and elevation) on the histologic features of lymphedema. A total of 118 skin-punch biopsy specimens were collected from the legs of 91 patients enrolled in a lymphedema treatment clinic in Léogâne, Haiti. Follow-up biopsy specimens were collected from 27 patients succeeds, equals 12 months later. Keratinocyte hyperproliferation, condensed dermal collagen, and mononuclear perivascular infiltrate increased with lymphedema stage, which suggested progressive chronic inflammation and fibrosis. Follow-up biopsies showed reductions in perivascular mononuclear infiltrate in the superficial dermis (41% decrease in prevalence), perivascular fibrosis in the deep dermis (58% decrease), and periadnexal mononuclear infiltrate (53% decrease). These data suggest that the clinical improvement commonly observed with basic lymphedema management has a histologic basis.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
authors.forename: Susan F
authors.initials: SF
authors.lastname: Wilson
authors.forename: Jeannette
authors.initials: J
authors.lastname: Guarner
authors.forename: Alix L
authors.initials: AL
authors.lastname: Valme
authors.forename: Jacky
authors.initials: J
authors.lastname: Louis-Charles
authors.forename: Tara L
authors.initials: TL
authors.lastname: Jones
authors.forename: David G
authors.initials: DG
authors.lastname: Addiss
mesh_terms: D000293:Adolescent; D000328:Adult; D020405:Dermis / Q000473:pathology*; D004049:Diethylcarbamazine / Q000627:therapeutic use; D004605:Elephantiasis, Filarial / Q000473:pathology* / Q000628:therapy; D004817:Epidermis / Q000473:pathology*; D005260:Female; D005369:Filaricides / Q000627:therapeutic use; D006205:Haiti; D006801:Humans; D008297:Male; D008875:Middle Aged; D012648:Self Care; D040521:Subcutaneous Tissue / Q000473:pathology*
chemical_list: D005369:Filaricides; D004049:Diethylcarbamazine