Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2022 Apr;23(4):289.
doi: 10.3892/etm.2022.11218. Epub 2022 Feb 16.

An integrative therapeutic approach to elephantiasis nostras verrucosa: A case report

Lawrence Chukwudi Nwabudike  1   2 , Olimpia Buzia  2   3 , Alina Mihaela Elisei  3   4 , Alin Laurentiu Tatu  2   4   5   6
Affiliations
Case Reports

An integrative therapeutic approach to elephantiasis nostras verrucosa: A case report

Lawrence Chukwudi Nwabudike et al. Exp Ther Med. 2022 Apr.

Abstract

Elephantiasis nostras is a chronic disorder that is difficult to treat. It is characterized by marked lymphedema, associated with hyperkeratosis, ulceration, deep skin folds and a cobblestone appearance of the skin. Causes include parasitic and bacterial infections, neoplasia and obesity, but numerous cases have uncertain aetiology. Treatment includes surgery and medication, which are associated with variable results. In the present study, a 72-year old female with renal insufficiency presented with leg enlargement of 3-4 years duration, which rendered her housebound. Examination showed massive lower limb enlargement, with typical cobblestone appearance. She was on furoseminde 80 mg/day. A diagnosis of elephantiasis nostras was made. Then, she was treated with increased furosemide from 80 to 120 mg daily and homeopathic Apocynum cannabinum, CH30 potency, t.d.s. Unavailability of corresponding fit excluded the use of compressive stockings. The patient remitted over 18 months, with limb diameters dropping from 68/46 cm (right mid-calf/ankle) and 67/43 cm (left mid-calf/ankle) to 64/43 cm (right mid-calf/ankle) and 64.5/45 cm (left mid-calf/ankle) at 6 months, 63/42 cm (right mid-calf/ankle) and 65/41 cm (left mid-calf/ankle) at 12 months, and 46/35 cm (right mid-calf/ankle) and 48/36 cm (left mid-calf/ankle) at 18 months, with improvement of skin appearance. Elephantiasis nostras is not spontaneously remitting. In this resource-limited setting, furosemide combined with homeopathic Apocynum cannabinum has proved valuable and may be used for similar cases.

Keywords: Apocynum cannabinum; elephantiasis nostras; furosemide; homeopathy; integrative medicine; lymphedema.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Image of the right leg, showing massive edema with deep folds, exudation, erythema and cobblestone appearance, more prominent than the left leg.
Figure 2
Figure 2
Image of the left leg, presenting massive edema with deep folds, exudation, erythema and cobblestone appearance.
Figure 3
Figure 3
Images of both legs with diminished edema, erythema, exudation and shallower skin folds.
Figure 4
Figure 4
Images of both legs with minimal edema, folds, cobblestone appearance and erythema ameliorated.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Liaw FY, Huang CF, Wu YC, Wu BY. Elephantiasis nostras verrucosa: Swelling with verrucose appearance of lower limbs. Can Fam Physician. 2012;58:e551–e553. - PMC - PubMed
    1. Molodoi AD, Dimitriu A, Andronic CD, Stoleriu G, Bădescu A, Boda D, Branisteanu DE. Pyoderma vegetans developed on chronic leg ulcer. Rev Med Chir Soc Med Nat Iasi. 2015;119:107–111. - PubMed
    1. Kerchner K, Fleischer A, Yosipovitch G. Lower-extremity lymphedema update: Pathophysiology, diagnosis, and treatment guidelines. J Am Acad Dermatol. 2008;59:324–331. doi: 10.1016/j.jaad.2008.04.013. - DOI - PubMed
    1. Merchant SJ, Chen SL. Prevention and management of lymphedema after breast cancer treatment. Breast J. 2015;21:276–284. doi: 10.1111/tbj.12391. - DOI - PubMed
    1. Casley-Smith JR, Casley-Smith JR. Modern treatment of lymphoedemas II. The benzopyrones. Australas J Dermatol. 1992;33:69–74. doi: 10.1111/j.1440-0960.1992.tb00082.x. - DOI - PubMed

Publication types