University College London Medical School, London, United Kingdom.
PLoS Negl Trop Dis. 2010 Nov 30;4(11):e902. doi: 10.1371/journal.pntd.0000902.
Podoconiosis is a non-filarial elephantiasis caused by long-term barefoot exposure to volcanic soils in endemic areas. Irritant silicate particles penetrate the skin, causing a progressive, debilitating lymphoedema of the lower leg, often starting in the second decade of life. A simple patient-led treatment approach appropriate for resource poor settings has been developed, comprising (1) education on aetiology and prevention of podoconiosis, (2) foot hygiene (daily washing with soap, water and an antiseptic), (3) the regular use of emollient, (4) elevation of the limb at night, and (5) emphasis on the consistent use of shoes and socks.
METHODOLOGY/PRINCIPAL FINDINGS: We did a 12-month, non-comparative, longitudinal evaluation of 33 patients newly presenting to one clinic site of a non-government organization (the Mossy Foot Treatment & Prevention Association, MFTPA) in southern Ethiopia. Outcome measures used for the monitoring of disease progress were (1) the clinical staging system for podoconiosis, and (2) the Amharic Dermatology Life Quality Index (DLQI), both of which have been recently validated for use in this setting. Digital photographs were also taken at each visit. Twenty-seven patients completed follow up. Characteristics of patients completing follow-up were not significantly different to those not. Mean clinical stage and lower leg circumference decreased significantly (mean difference -0.67 (95% CI -0.38 to -0.96) and -2.00 (95% CI -1.26 to -2.74), respectively, p<0.001 for both changes). Mean DLQI diminished from 21 (out of a maximum of 30) to 6 (p<0.001). There was a non-significant change in proportion of patients with mossy lesions (p = 0.375).
CONCLUSIONS/SIGNIFICANCE: This simple, resource-appropriate regimen has a considerable impact both on clinical progression and self-reported quality of life of affected individuals. The regimen appears ideal for scaling up to other endemic regions in Ethiopia and internationally. We recommend that further research in the area include analysis of cost-effectiveness of the regimen.
Podoconiosis 是一种非血丝虫性象皮病，由长期赤脚暴露在流行地区的火山土壤中引起。刺激性硅酸盐颗粒穿透皮肤，导致小腿进行性、衰弱性淋巴水肿，通常始于生命的第二个十年。已经开发出一种适用于资源匮乏环境的简单以患者为中心的治疗方法，包括（1）病因和预防 Podoconiosis 的教育，（2）足部卫生（每天用肥皂、水和防腐剂清洗），（3）定期使用润肤剂，（4）夜间抬高肢体，以及（5）强调始终如一地穿鞋和袜子。
方法/主要发现：我们对埃塞俄比亚南部一个非政府组织（Mossy Foot Treatment & Prevention Association，MFTPA）的一个诊所新出现的 33 名患者进行了为期 12 个月的非比较性纵向评估。用于监测疾病进展的结果测量包括（1）Podoconiosis 的临床分期系统，（2）Amharic Dermatology Life Quality Index（DLQI），这两者都已最近在该环境中得到验证。每次就诊时还拍摄了数码照片。27 名患者完成了随访。完成随访的患者的特征与未完成随访的患者没有显著差异。临床分期和小腿周长均显著降低（平均差异分别为-0.67（95%CI-0.38 至-0.96）和-2.00（95%CI-1.26 至-2.74），p<0.001）。平均 DLQI 从 21（最高 30）降至 6（p<0.001）。苔藓病变患者的比例无显著变化（p=0.375）。
结论/意义：这种简单的、适合资源的方案对受影响个体的临床进展和自我报告的生活质量都有很大的影响。该方案似乎非常适合在埃塞俄比亚和国际上的其他流行地区推广。我们建议该领域的进一步研究包括该方案的成本效益分析。
