EPISODIC DERMATOLYMPHANGIOADENITIS (DLA) IN PATIENTS WITH LYMPHEDEMA OF THE LOWER EXTREMITIES BEFORE AND AFTER ADMINISTRATION OF BENZATHINE PENICILLIN: A PRELIMINARY STUDY

Abstract

Dermatolymphangioadentis (DLA) is a common and serious complication of obstructiveperipheral lymphedema. The clinical characteristerics of acute DLA are local tenderness anderythema of the skin, sometimes red streaks along the distribution of the superficial lymphaticsand enlarged inguinal lymph nodes. Systemic symptoms include malaise, fever and chills. In itssubacute or latent form, only skin involvement is observed. Each episode of DLA is commonlyfollowed by worsening of leg swelling. Numerous clinical studies suggest that administration ofantibiotic drugs interrupt the acute episodes and prevent their recurrence. We investigated theclinical course of lymphedema with respect to the prevalence of DLA in patients receivinginjections of long-acting penicillin (benzathine penicillin). Forty-five randomly selected patientswith obstructive lymphedema of the lower limbs were included in an open clinical trial. Theinclusion criteria was stage II-IV lymphedema of postsurgical, posttraumatic, and postdermatitistype with at least 3 previous episodes of DLA. Benzathine penicillin (PCN) was given after thelast presenting episode of DLA in a dose of 1,200,000 u, intramuscularly at 3-week intervals, forat least one year. Each patient was reevaluated at 3-month intervals. They were instructed inearly diagnosis of DLA and reported promptly to the responsible senior surgeon with prodromesymptoms of recurrent DLA. The duration of lymphedema before initiation of therapy was 7months to 40 years and the frequency of DLA was 1-6 episodes per year. PCN administrationlasted for at least one year but was extended in all patients because of the tendency forrecurrence of DLA after cessation of PCN injections. In 26 of these patients, PCN administrationextended to over 5 years and in 2 over 10 years. Recurrent episodes of DLA occurred in thePCN-treated group during one year follow-up in only 4 of the 45 patients (9%). The frequencyepisodes in 3 patients with recurrent DLA was 1-2/year; in one patient, no positive effect of PCNtherapy was observed. There were no apparent side effects of long-term PCN therapy.These data, although evaluated without a placebo group, suggest that long-term PCNadministration decreases the frequency of DLA attacks and furthermore provide justification for