THE EFFECTS OF UNGUENTUM LYMPHATICUM ON SKIN IN PATIENTS WITH OBSTRUCTIVE LYMPHEDEMA OF THE LOWER EXTREMITIES

Abstract

Obstructive lymphedema of extremities in humans is characterized by swelling of tissueswith lymph stasis and inflammatory infiltrates in skin and subcutaneous tissues. Treatment of theinflammatory component requires application of antiinflammatory drugs. We studied the effect oftopical application of Unguentum Lymphaticum (UL) containing antiphlogistic compounds(digitalis, calendulin, hyoscyamine, colchicine and podophyllin) on lymphedematous skin in 33patients with stage II postinflammatory obstructive lymphedema. A three-week treatment ofswollen legs with UL brought about stimulation of epidermal cells with proliferation ofkeratinocytes, increased numbers of Langerhans cells, accumulation of macrophages in thedermis and activation of infiltrating cells and endothelia. Besides some foci of acanthosis, nodegenerative changes were observed in the skin in patients treated for 12 weeks and no changeswere observed in the placebo treated groups. Immunohistochemical evaluation of biopsyspecimens of inguinal lymph nodes in patients treated for 12 weeks revealed reactive granulocyteand macrophage accumulation in the cortical and paracortical areas. Components of ULinhibited stimulation of blood mononuclear cells in in vitro cultures. UL did not change thespectrum of calf skin bacterial populations. The nonspecific stimulation of skin-associatedlymphoid tissue and putative elimination of factors responsible for lymphedematous skininflammation appears to be responsible for the beneficial clinical effect of UL on legs with lymphstasis.