Lymphovenous Canada: The International League of Dermatology Societies (ILDS)

The large numbers of persons affected by lymphatic filariasis in tropical countries provide dermatologists in these regions great opportunities to establish expertise in diagnosing lymphatic conditions and related skin conditions.

To put this problem into perspective, dermatological disorders are among the five most common causes of disease and of loss of manpower in rural areas in developing countries. (In Africa alone, 80 per cent of its population live in rural areas.) Of common skin diseases which affect patients in developing countries, about 70 per cent involve infections. Source: Healthy Skin for All: a multi-faceted approach, by the International Committee on Dermatology, 1997, pgs. 6 and 13.

On the international front, one organization promoting greater awareness and dedication to skin disorders is the International League of Dermatology Societies (ILDS) and its project arm, the International Foundation of Dermatology (the latter is overseen by the International Committee of Dermatology). They are part of a global alliance working to eliminate the transmission of infection (often part of lymphatic filariasis) and alleviate/prevent suffering and disability.

The ILDS points out that skin diseases have social and economical consequences causing both disability and disfigurement in the individuals affected. Many ILDS specialists encourage their patients to maintain health through prevention and treatment, so they can continue to support their families and avoid destitution. (This goal is very similar to the principles of the independent living movement in Canada and the U.S.: i.e. to facilitate independence rather than encourage dependency by persons with disabilities.) The activities of this organization and its foundation have the full support of the World Health Organization.

Several major projects have been funded by the Foundation with the goal of training local experts in this area. These include the Regional Dermatology Training Centre in Moshi, Tanzania (established by Professors Alfred Kopf of the USA, Terrance Ryan of England and Stuart Maddin of Canada) which focuses on developing fully-fledged dermatology officers. Several complementary programs are also underway in Chimaltenango, Guatemala and Francophone West Africa spearheaded by Professor Henning Grossmann. These programs focus on training nurses in rural health centres. (The publication "Healthy Skin for All" describes both programs and outlines the principles and purposes of the ILDS.)

In many of these countries bandaging, hosiery and manual lymph drainage do not exist or are too costly for most individuals. Given the limited resources of these centres and of the people who use them, one of the projects' primary purposes has been to develop low cost approaches to treating infection and preventing potential morbidity.

One of these approaches has been to utilize and build on traditional medicine used by local people. With the acute shortage and frequent non-availability of essential drugs for the treatment of dermatological conditions natural remedies are becoming increasingly important in maintaining health in African countries. The Moshi Training Centre, in particular, has done a great deal of work in studying the use of traditional medicine in the treatment in dermatology. Several studies in Africa (Nggwatu, 1993; Matsenjwa, 1994) have shown that traditional healers are able to successfully treat skin diseases by both oral and topical treatments.

Locally available herbs obtained from leaves and roots mixed with other products such as honey, oil and sugar cane juice, are used to treat cutaneous bacterial infections, scabies, urticaria, eczema and fungal infections as well as other common tropic diseases. Traditional healers have developed sophisticated methods at arriving at a diagnosis by using a combination of patient histories and physical diagnosis. They have been less effective in the area of preventative dermatology, however.

The ILDS has urged the international community to continue to support the Global Initiative for Traditional Systems (GIFTS), established with support from WHO in 1993, to promote effective traditional medicine world-wide and to study the efficacy of these forms of treatment WHO Policy and Strategy on Traditional Medicine .

In the attached article, An Update on the Low Cost Management of Lymphoedema in the Developing World, Professor Terrance Ryan of Oxford University and a member of the International Committee of Dermatology reports on the relationship between inflammation and increased vulnerability to lymphatic overload in lymphatic disease. He talks about dermatological treatments related to lymphatic conditions and low cost treatments, drawing from his African experiences.

For more information on the International League of Dermatology Societies (ILDS) check out their web site at: http://www.ilds.org/