title: Dermal Structure in Lymphedema Patients with History of Acute Dermatolymphangioadenitis Evaluated by Histogram Analysis of Ultrasonography Findings: A Case-Control Study.
abstract: BACKGROUND
  Acute dermatolymphangioadenitis (ADLA) is a risk factor for increasing of edema and worsening severity. Reducing ADLA frequency is an important objective of lymphedema management because ADLA episodes are strongly associated with poor quality of life. Lymphedema changes dermal and subcutaneous structure, favoring ADLA; ADLA recurrence may be caused by structural change of the dermis. However, the structure of the skin following ADLA episodes has not been studied in depth. The aim of this study was to examine changes in the skin after episodes of ADLA in breast cancer-related lymphedema (BCRL) using histogram analysis of ultrasonography findings.
  
  
  RESULTS
  This was a case-control study with matching for the duration of lymphedema. We compared 10 limbs (5 BCRL patients, Cases) with a history of ADLA and 14 limbs (7 BCRL patients, Controls) without. Ultrasonography was performed using a 20-MHz probe, and measurements were made at a site 10 cm proximal to the ulnar styloid process. We compared "skewness" of the images in the dermis from the histogram analysis. This study was approved by the Ethics Committee of Kanazawa University. Skewness was significantly different between the affected and unaffected limbs (p = 0.02). Cases showed a positive value (median 0.74, range -0.18 to 1.26), whereas Controls showed a negative value (median -0.21, range -0.45 to 0.31).
  
  
  CONCLUSIONS
  Episodes of ADLA changed the distribution of echogenicity on imaging, which indicates a change in the collagen fibers in the dermis. These findings might contribute to improving the management of lymphedema and prevention of recurrent ADLA.
authors.affiliation: 1 Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University , Ishikawa Prefecture, Japan .
authors.forename: Misako
authors.initials: M
authors.lastname: Dai
authors.affiliation: 2 Graduate School of Medical Sciences, Division of Health Science, Graduate Course of Nursing Science, Kanazawa University , Ishikawa Prefecture, Japan .
authors.forename: Aya
authors.initials: A
authors.lastname: Sato
authors.affiliation: 3 Career Design Laboratory for Gender Equality, Kanazawa University , Ishikawa Prefecture, Japan .
authors.forename: Hiroko
authors.initials: H
authors.lastname: Maeba
authors.affiliation: 2 Graduate School of Medical Sciences, Division of Health Science, Graduate Course of Nursing Science, Kanazawa University , Ishikawa Prefecture, Japan .
authors.forename: Terumi
authors.initials: T
authors.lastname: Iuchi
authors.affiliation: 2 Graduate School of Medical Sciences, Division of Health Science, Graduate Course of Nursing Science, Kanazawa University , Ishikawa Prefecture, Japan .
authors.forename: Masaru
authors.initials: M
authors.lastname: Matsumoto
authors.affiliation: 1 Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University , Ishikawa Prefecture, Japan .
authors.forename: Mayumi
authors.initials: M
authors.lastname: Okuwa
authors.affiliation: 1 Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University , Ishikawa Prefecture, Japan .
authors.forename: Toshio
authors.initials: T
authors.lastname: Nakatani
authors.affiliation: 4 Department of Gerontological Nursing/Wound Care Management, Division of Health Science and Nursing, Graduate School of Medicine, University of Tokyo , Japan .
authors.forename: Hiromi
authors.initials: H
authors.lastname: Sanada
authors.affiliation: 1 Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University , Ishikawa Prefecture, Japan .|5 Wellness Promotion Science Center, Kanazawa University , Ishikawa Prefecture, Japan .
authors.forename: Junko
authors.initials: J
authors.lastname: Sugama
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000072656:Breast Cancer Lymphedema / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D016022:Case-Control Studies; D003094:Collagen / Q000378:metabolism; D005260:Female; D006801:Humans; D008205:Lymphangitis / Q000150:complications / Q000000981:diagnostic imaging*; D008875:Middle Aged; D012867:Skin / Q000378:metabolism / Q000473:pathology*; D012871:Skin Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D014463:Ultrasonography / Q000379:methods*; D034941:Upper Extremity / Q000473:pathology
chemical_list: D003094:Collagen