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                        ==LYMPHOEDEMA==

7
AUTHOR                    Casley-Smith JR
TITLE                     Modern treatment of lymphoedema. II. The
                          benzopyrones.
SOURCE                    Australas J Dermatol; VOL 33, ISS 2, 1992,
                          P69-74 (REF: 9)
ABSTRACT                  The benzo-pyrones reduce all high-protein
                          oedemas, including lymphoedema and
                          elephantiasis, by increasing the numbers of
                          macrophages and their normal proteolysis.
                          Thus they remove the excess protein, and
                          thereby the oedema which is caused by it.
                          They also remove the stimulus it provides for
                          chronic inflammation and fibrosis, and its
                          action as a culture medium for bacteria.
                          Coumarin (5,6 benzo-[alpha]-pyrone, 56 BaP)
                          and oxerutins (HR,
                          O(beta-hydroxy-ethyl)-rutosides) have been
                          used in many clinical trials on a variety of
                          high-protein oedemas. Four such trials are
                          summarised here: on lymphoedema and
                          elephantiasis (from many causes in Australia,
                          and filaritic in India and China). The drugs
                          reduced these much more slowly than adequate
                          physical therapy, but they did reduce them.
                          About half the excess volume was removed over
                          six months in the Australian trials. In India
                          and China similar rates were achieved with
                          lymphoedema, but elephantiasis reduced at a
                          slower rate. The benzo-pyrones convert a
                          slowly worsening condition into a slowly
                          improving one. No compression garments are
                          necessary. In addition, the drugs
                          considerably reduce the number of attacks of
                          secondary acute infection, reduce the
                          deformities of elephantiasis and considerably
                          improve the patients' comfort and mobility.
                          They may be taken orally, or applied
                          topically, have very low toxicities and only
                          few, minor side-effects. They are useful in
                          many other forms of high-protein oedema, and
                          improve the results of physical therapy for
                          lymphoedema.

6
AUTHOR                    Zouboulis CC
AUTHOR                    Biczo S
AUTHOR                    Reupke HJ
AUTHOR                    Rinck G
AUTHOR                    Orfanos CE
AUTHOR                    et al
TITLE                     Elephantiasis nostra verrucosa: beneficial
                          effect of oral etretinate therapy
SOURCE                    Br. J. Dermatol.; VOL 127 ISS Oct 1992,
                          P411-416, (REF 46)
ABSTRACT                  IPA  COPYRIGHT: ASHP  The successful
                          treatment of elephantiasis nostras verrucosa
                          in 3 obese women, ages 67, 82, and 98 yr,
                          with oral etretinate is described. Rapid
                          disappearance of the hyperkeratotic and
                          verrucous lesions, remarkable flattening of
                          the papillomatous nodules, and improvement of
                          lymphoedema occurred using an initial dose of
                          0.6 to 0.75 mg/kg daily for 4-6 wk.

1 
AUTHOR                    Casley-Smith JR 
AUTHOR                    Jamal S 
AUTHOR                    Casley-Smith J 
TITLE                     Reduction of filaritic lymphoedema and 
                          elephantiasis by 5,6 benzo-alpha-pyrone 
                          (coumarin), and the effects of 
                          diethylcarbamazine (DEC). 
SOURCE                    Ann Trop Med Parasitol; VOL 87, ISS 3, 1993, 
                          P247-58 
ABSTRACT                  Chronic filaritic lymphoedema and 
                          elephantiasis, in India, were treated orally 
                          with 5,6 benzo-alpha-pyrone (56 BaP; 1,2 
                          benzo-alpha-pyrone; coumarin) in a 
                          double-blind, randomized, matched-group 
                          trial. Each group finally contained 40-55 
                          patients. Patients were observed for about 2 
                          years (ranging from 6 to 45 months, with 75% 
                          completing the 2 years). The 56 BaP slowly, 
                          but very significantly (P < 0.0001), reduced 
                          all grades of lymphoedema and elephantiasis. 
                          Two thirds of the oedema was lost by grade 2 
                          over 2 years. Grades 3 to 5 were reduced by a 
                          fifty over that time. The greater the initial 
                          oedema, the greater was its rate of 
                          resolution. A slowly worsening condition thus 
                          became a slowly improving one. Slowness has 
                          its advantages: compression stockings, that 
                          are impractical in hot, wet or dirty 
                          conditions, are not necessary. The slowly 
                          remodelling fibrous tissue, while lessening 
                          in amount, is still able to hold the tissues 
                          together. The 56 BaP considerably improved 
                          many symptoms and complications, particularly 
                          bursting-pains, inflammation and ulcers. It 
                          is cheap and of very low toxicity. 
                          Diethylcarbamazine (DEC) was studied with and 
                          without 56 BaP. DEC alone gave some reduction 
                          of the oedema, but this was much smaller than 
                          that with 56 BaP. It considerably worsened 
                          the reductions by 56 BaP, while 56 Bap 
                          slightly improved those by DEC and reduced 
                          the fever caused by DEC. Together, they 
                          reduced feelings of swelling and 
                          bursting-pain, fungal infections, 
                          lymphangitis and lymphadenitis more than when 
                          used alone.