Podoconiosis

Author: Freya Forstner, 5th Year Medical Student, University of Auckland, New Zealand. DermNet New Zealand Editor in Chief: Hon A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. 

What is podoconiosis?

Podoconiosis, also known as nonfilarial elephantiasis, is a form of lymphoedema affecting the lower limbs that occurs in people with long-term exposure to volcanic red clay soil.

Creator: Fasil Ayele, National Institutes of Health [https://commons.wikimedia.org/wiki/File:Ethiopian_Farmer_affected_by_Podoconiosis_-_NIH_-_2011.jpg], via Wikimedia Commons

Who gets podoconiosis?

Podoconiosis is endemic in tropical regions of Africa, Asia and Central America.  

What causes podoconiosis?

Podoconiosis is a genetically determined abnormal inflammatory reaction to mineral particles in red clay soils derived from volcanic deposits. The suggested pathogenesis is:

There is no contagious or infectious organism identified.

What are the clinical features of podoconiosis?

Cutaneous symptoms and signs associated with podoconiosis include:

Podoconiosis is a chronic condition commonly complicated by acute episodes of lymphadenitis, especially when fibrotic. Acute lymphadenitis presents as:

Podoconiosis presents with ascending lymphoedema.

Podoconiosis has an early prodromal phase prior to the development of elephantiasis.

Acute attacks resolve spontaneously after a few days of rest and elevation. Subsequent episodes typically affect the same limb. Patients have an acute attack on average five times a year [1, 2].

Podoconiosis staging

The following staging system was designed for use by field workers. Each leg should be staged separately for:

Stage one: swelling reversible overnight.

The swelling is not present when the patient first gets up in the morning.

Stage two: below-knee swelling that is not completely reversible overnight. If present, knobs/bumps are below-knee ONLY.

Stage three: below-knee swelling that is not completely reversible overnight; knobs/lumps present above the ankle

Stage four: Above-knee swelling that is not completely reversible overnight; knobs/bumps present at any location.

Stage five: Joint fixation; swelling at any place in the foot or leg

What are the complications of podoconiosis?

Complications of podoconiosis include:

How is podoconiosis diagnosed?

Podoconiosis is diagnosed clinically. Diagnosis is based on clinical features, patient history and exclusion of other causes of lymphadenitis.  

What is the differential diagnosis for podoconiosis?

Podoconiosis differential diagnosis includes other causes for elephantiasis:

What is the treatment for podoconiosis?

Podoconiosis treatment aims to reduce lymphoedema and to prevent relapse by reducing re-exposure to the causative soil.

Primary prevention requires avoiding prolonged contact between skin and soil.

Treatment after podoconiosis has occurred involves:

More severe disease may require:

Surgical management has been attempted. Shave excision of hard nodules has been used with secondary intention healing. Surgical removal of tissue followed by skin grafting (Charles operation) is unsuccessful, as scar tissue aggravates symptoms [1].

What is the outcome for podoconiosis?

Podoconiosis results in progressive swelling and disfigurement of the limbs. Untreated patients are typically in constant pain and discomfort and may suffer from chronic infections. Due to social stigmatism, individuals with podoconiosis are often ostracised from their communities [1, 2].

Related information

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