Elephantiasis is an abnormal enlargement of a body part caused by lymphatic congestion. It usually affects the legs or external genitals. The condition is either caused by a worm infection or is congenital.
What is elephantiasis?
Elephantiasis is a collective term for diseases caused by a disorder of lymphatic drainage. You can take the term elephantiasis literally if you want to imagine what elephantiasis looks like. Those affected really make an elephantine impression. Especially arms and legs are affected by elephantiasis. There is a partly gigantic soft swelling, which can still be pressed in at the beginning of the elephantiasis. In the course of years the swelling hardens. Then the disease can no longer be reversed.
Causes
In about one in five elephantiasis patients, weakness of the lymphatic vessels is congenital. In healthy people, the lymphatic vessels transport body fluid that has left the blood vessels back to the heart like a drainage system. If, on the other hand, the lymph vessels are defective and have become impermeable, body fluid accumulates and the affected part of the body swells. Congenital elephantiasis by no means always occurs at birth. It may even appear after the age of 35. In most cases of elephantiasis, another disease leads to occlusion of the lymphatic vessels. Usually, these are persistent and protracted infectious diseases such as erysipelas, herpes simplex on the lips, leprosy and the so-called filariasis, a tropical disease. In some cases, a cancer is responsible for the destruction of the lymphatic vessels. Lymphatic vessels can also be damaged by surgery. Elephantiosis tropica, or lymphatic filariasis, occurs frequently in the tropics. The worms settle in the lymphatic vessels and lymph nodes of humans. Female worms lay hundreds of eggs. Insects ingest the larvae that develop from the eggs during a blood meal. A bite transmits the larvae to another person through the sting canal.
Symptoms, complaints, and signs
The first symptoms are usually redness and swelling of the skin around the arms and legs. Inflammatory allergic reactions are triggered by the worms growing in the lymphatic systems. Associated with episodes of fever, arms, legs, testicles and female breast swell with general malaise. The above infections must heal in any case. If swelling subsequently appears on the arms and legs, but also on other parts of the body, an examination is necessary in any case. Since many very different underlying diseases can lead to elephantiasis, the diagnosis begins with a precise physical examination and review of the medical history. This usually leads to a suspicion, which the doctor can then specifically investigate. If swelling of the arms and legs occurs after a stay in the tropics, it is essential that you draw your doctor’s attention to your trip. This can be an important clue to finding a diagnosis. Edema of the legs is usually caused by heart disease or venous disease. However, this symptom does not count as elephantiasis.
Course
Provided that the underlying disease can be treated in time, then the chances are high that elephantiasis will disappear. If the swellings persist or the cause cannot be eliminated, then treatment may be required for life. Elephantiasis in itself is an unpleasant disease, but in most cases it is otherwise harmless.
When should you see a doctor?
When redness, itching, and swelling of the skin around the arms and legs are noticed, a doctor should be consulted. At the latest, if other symptoms of elephantiasis are added, this requires immediate clarification. For example, anyone who experiences unusual fever episodes and a general feeling of malaise that cannot be attributed to any other cause must definitely discuss this with their family doctor. This is especially true if the symptoms occur after a trip to the tropics or after overcoming cancer. Although the disease itself is not life-threatening, the complications can cause serious health problems. For this reason alone, a medical professional should be consulted quickly if elephantiasis is suspected.If the above symptoms occur in conjunction with another infectious disease, it is best to consult the appropriate physician. The same applies if edema is noticed on the legs. These can occur as an accompanying symptom and indicate that elephantiasis is already more advanced – an immediate visit to the doctor is advisable.
Complications
Elephantiasis (lymphatic congestion) cannot be treated curatively. With appropriate therapeutic measures, the backlog of lymphatic fluids and associated swelling can be managed. If elephantiasis is caused by filariae and worm larvae, the physician first tries to kill the pathogens by administering various drugs or to keep the pathogen load as low as possible. Complications are then seen in the side effects of the respective drugs. The swelling of the extremities caused by elephantiasis can only be treated by consistent wearing of compression stockings and frequent application of lymphatic drainage. If both are omitted, the swellings become so massive that the patient’s daily life is considerably restricted. Massive swelling of the legs can possibly lead to loss of mobility. The treatment of elephantiasis is very time-consuming for the patient and despite the considerable effort, not always successful. In addition, the wearing of compression stockings and bandages does not meet the fashion requirements of today. As a result, many patients suffer not only from elephantiasis itself, but also from the treatment of the same. Since not all services are covered by health insurance, patients not infrequently face financial problems as well.
Treatment and therapy
Of course, the underlying disease, if any, which usually exists for months and years, must first be treated effectively. Swelling in the arms and legs can be improved with compression stockings, which are made to measure. In addition, lymphatic drainage (a special massage technique) and decongestant medications have an alleviating effect. In recent years, microsurgical transplants of lymphatic vessels have also been performed with increasing success. Filariae and larvae can be killed with medication. Adequate hygiene and disinfection are essential to prevent bacterial colonization of wounds. Pressure bandages can also reduce swelling. However, no real cure or therapy is possible for elephantiasis.
Outlook and prognosis
Elephantiasis is not curable. However, because it is not a uniform disease, there is also no uniform course. However, in many people, the symptomatology can be treated in such a way that there is a regression of the swellings. The therapy usually consists of the application of manual lymphatic drainage. With the help of lymphatic drainage, the patient can lead a normal life in most cases. However, if the therapy is suspended, lymph congestion immediately resumes and the limbs or genitals swell enormously again. Treated patients suffer from overstretched skin that can only be corrected by plastic surgery. However, complete reconstruction of the skin structure is not possible. In severe cases of elephantiasis, even manual lymphatic drainage no longer helps. Then amputation of affected limbs may also become necessary. The further prognosis depends on the underlying disease. Successful symptomatic therapy of elephantiasis can only succeed if the underlying disease is also successfully treated. This is especially true in cases of infections leading to elephantiasis or genetic causes of lymphatic congestion. Forms of elephantiasis caused by tumors have a worse prognosis. Here, successful lymphatic drainage is not possible and surgical removal of the tumors in elephantiasis only increases the further spread of the cancer throughout the body. With luck, only amputation of the affected limbs can still be life-saving in this case.
Prevention
Effective prevention of elephantiasis tropica includes the following measures: Killing mosquitoes by spraying and administering antibiotics to prevent infection. In addition, it is important to kill the microfilaria circulating in the blood by drug treatment, with the help of (4) pressure bandages can reduce swelling.In borderline cases, only surgical removal of the infected tissue helps. Compression stockings can only be effective in congenital elephantiasis if they are worn. Often it is for cosmetic reasons that the stockings are kept in the closet. However, this is short-sighted. If the swellings are not treated in time, hardening can occur, which can then no longer be treated. Elephantiasis should be treated by elevating the legs as often as possible.
Aftercare
Elephantiasis always requires immediate treatment by a doctor. Since this disease also cannot heal itself, a doctor should always be consulted in this case at a very early stage at the first signs. As a rule, patients with elephantiasis do not have any special measures or options for aftercare. Therefore, the main focus of this disease is always an early detection with further treatment. The treatment itself is usually carried out with the help of compression stockings. Especially in children, parents should pay attention to the regular and correct wearing of these stockings to avoid further complications. In some cases, however, surgical intervention is necessary. In this case, strict bed rest should be maintained afterwards. The affected person should not exert himself unnecessarily, nor should he engage in sports or stressful activities. A complete cure of elephantiasis is not always possible. Care by one’s own family or friends can also have a positive effect on the course of the disease. Not infrequently, contact with other patients of elephantiasis is also useful in this regard.
This is what you can do yourself
It is important to treat the edema regularly, especially in everyday life, to avoid pain and secondary diseases. This includes, above all, sensible exercise. Especially sports like water gymnastics, i.e. aqua jogging, aqua cycling or aqua aerobics support the lymph to drain the fluid. Courses are offered regularly in swimming pools or therapy facilities. In some cases, health insurance companies also cover the costs. The water exerts a pressure on the body that decreases towards the top. In this way, the lymphs can be supported in their transport. In addition, the joints are relieved and calories are burned, which leads to a gentle weight loss and thus additionally increases the freedom of movement. However, those affected must exercise at least twice a week to achieve meaningful results. Compression garments are worn for this purpose. The combination of exercise and pressure allows tissue fluid to drain better and venous blood to be transported out of the legs. Skin care is also important in elephantiasis. This is because the skin barrier is no longer functional due to the constant swelling. Thus, bacteria and viruses can penetrate more quickly and cause infections. To avoid this, perfumed products should be avoided. Natural, mild lotions and creams with oils and aloe vera are well suited for the area of edema. Regular care will help prevent infections. Dry skin can be cared for with urea, lactic acid and sorbitol. Products containing mineral oils should be avoided.
