Benzopyrones (b.): Include coumarin and derivatives (alpha-b.) and bioflavonoids and derivatives (gamma-b. – diosmin, rutin, hesperidin, quercetin, etc.).
The activity of alpha-b. consists of:
- Increase in capillary tone
- Decreased capillary permeability to proteins
- Increase in macrophage numbers
- Activation of macrophage proteolytic activity
- Stimulation of the propulsive activity of the lymphangion
- Inhibition of the synthesis of prostaglandins and leukotrienes
Therefore, the effects are:
- Interstitial fluid reabsorption
- Gradual regression of fibrosis, favored by macrophage proteolysis
- Reduction of chronic inflammatory stimulation, with consequent lower incidence of acute episodes and less tendency of the edema towards fibrosis.
Natural cumarins, administered at doses of 8 mg / day for 60 days, have shown therapeutic efficacy with improvement in subjective symptoms, functional recovery of the lymphedematous limb, reduction of edema consistency, enhancement of excess volume reduction obtained after sequential physical and / or microsurgical-liposuction treatment, without causing any toxic effect for the liver.
The actions of the gamma-b. include:
- Reduction of permeability of the endothelium to protein macromolecules
- Reduction of capillary filtration
- Increase in venular tone
Therefore, the effects are:
- Stabilizing action on the interstitial connective tissue and on the capillary wall.
- Inhibition of the production of prostaglandins and leukotrienes.
- Antibiotics: are used in the acute phase (therapy for Beta-hemolytic streptococcus), for the treatment of dermato-lymphangio-adenitis (DLA), and for preventive purposes for the prophylaxis of episodes of acute lymphangitis (long-lasting penicillin).
- Antifungals: for the treatment of fungal infections of the extremities (fluconazole, etc.).
- Diethylcarbamazine: for the elimination of microfilaria from the bloodstream in patients with parasitic-based lymphedema.
- Diuretics: usually at low dosage and for short periods of treatment, especially in lymphedema associated with phlebedema or other diseases such as cardiopathies, kidney disease, ascites, pathologies of chyliferous vessels, etc.
- Diet: in obese patients, the reduction of caloric intake, in association with a suitable program of physical activity, has its own specific effectiveness in reducing the volume of the lymphedematous limb. The validity of a limited intake of fluids has not been demonstrated. In syndromes with chylous reflux, a diet low in lipids and with the exclusive intake of medium chain triglycerides (medium chain triglycerides – MCT), which are absorbed through the portal circuit, and therefore do not overload the system of chyliferous vessels, is extremely effective, even in the pediatric age.
Therefore, there is a wide range of pharmacological therapeutic principles. The choice is based on the etiopathogenetic and pathophysiological aspects of each type of lymphedema.