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Podoconiosis

Podoconiosis
Ethiopian Farmer affected by Podoconiosis - NIH - March 2011.jpg
Bilateral lower extremity swelling and "mossy" hyperkeratotic papillomata characteristic of podoconiosis
Classification and external resources
Specialty Medical genetics
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Podoconiosis, also known as nonfilarial elephantiasis, is a disease of the lymph vessels of the lower extremities that is caused by chronic exposure to irritant soils. It is the second most common cause of tropical lymphedema after filariasis, and it is characterized by prominent swelling of the lower extremities, which leads to disfigurement and disability.

The primary symptom of podoconiosis is swelling and disfigurement of the lower extremities. The swelling can either be soft and fluid or hard and fibrotic. Multiple firm nodules may develop over time, as well as hyperkeratotic papillomata that resemble moss, which has led to the disease's alternate name of Mossy Foot. The edema of podoconiosis is usually bilateral and asymmetric. Prior to the development of lymphatic failure and frank lymphedema, a prodrome consisting of itching, burning, hyperkeratosis, plantar edema, and rigid digits may occur. As with other forms of tropical lymphedema, chronic disease can lead to fusion of the toes, ulceration, and bacterial superinfection. The disease has an acute component, and sufferers may experience recurrent episodes of lower extremity warmth, firmness, and pain.

According to the World Health Organization (WHO):

“Evidence suggests that podoconiosis is the result of a genetically determined abnormal inflammatory reaction to mineral particles in irritant red clay soils derived from volcanic deposits.”

The pathophysiology of podoconiosis is a combination of an uncharacterized genetic susceptibility and a cumulative exposure to irritant soil. In susceptible individuals, silicate particles from irritant soils are apparently absorbed through the feet and collect in lymphatic vessels and nodes. Over time, subendothelial edema occurs within the lymphatic vessels and collagenization of the lumen leads to complete blockage. The genetic susceptibility to podoconiosis has not been elucidated, and it has alternatively been suggested to be autosomal recessive or autosomal co-dominant.


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