# What disease is this in this picture? **URL:** \ **Category:** Factual Questions\ **Created:** [December 7, 2006, 9:31pm UTC](https://boards.straightdope.com/t/what-disease-is-this-in-this-picture/383269 "2006-12-07T21:31:20Z")\ **Posts on this page:** 18\ **Page:** 2
**Author:** ![Zany\_Zeolite\_Zipper](https://avatars.discourse-cdn.com/v4/letter/z/4af34b/32.png) [@Zany\_Zeolite\_Zipper](https://boards.straightdope.com/u/Zany_Zeolite_Zipper)\ **Post date:** [December 8, 2006, 2:58pm UTC](https://boards.straightdope.com/t/what-disease-is-this-in-this-picture/383269/21 "2006-12-08T14:58:15Z")
[QUOTE=Paul in Saudi] It could be an old, old photo of someone with Guinea Worm. It has been extinct for some time now. I am guessing from the number of lesions in the upper level of the skin. Or something else. [/QUOTE] Isn’t the Guinea Worm the disease that Alex Trebek is always pimping? A couple times a year for a few weeks at a time the TV will play an Alex Trebek special about kids in African countries, and the Guinea Worm always makes an appearance. [Dracunculus medinensis - Wikipedia](http://en.wikipedia.org/wiki/Guinea_worm) implies that the Guinea Worm is still present in some areas ---
**Author:** ![choosybeggar](https://avatars.discourse-cdn.com/v4/letter/c/8c91f0/32.png) [@choosybeggar](https://boards.straightdope.com/u/choosybeggar)\ **Post date:** [December 8, 2006, 3:28pm UTC](https://boards.straightdope.com/t/what-disease-is-this-in-this-picture/383269/22 "2006-12-08T15:28:39Z")
[QUOTE=bigbabysweets2000] Although I’m sure that I could be wrong and all these answers look good, I would really like to hear some explanations about why they \*do not \* think this is elephantiasis. I know the skin looks more infected and necrotic than a lot of the “classic” photos of the disease, but I don’t understand how that rules it out. [/QUOTE] The photo _is_ consistent with elephantiasis, but is also consistent with other processes. First, a discussion on what I believe is a point of confusion in this thread: elephantiasis is synonymous with lymphedema. In Wuchereria bancrofti infestation (the filarial etiologic agent of infectious elephantiasis) the organisms cause blockage of the lymphatic vessels producing marked lymphedema. However, there are other means to get to lymphedema. In my practice, I see this problem in individuals with long-standing swelling of their legs from any cause (with heart failure, liver disease, kidney disease, obesity, leg injury, and back flow of blood in the leg veins as the most common causes). The photo I posted, though, demonstrates that the appearance of lymphedema can be mimicked by severe myxedema, which has a distinct pathophysiology. It is not uncommon for skin diseases to mimic one another in this manner. Often, a visual examination of the skin fails to yield a single certain diagnosis. Instead, a list of contenders, termed a differential, is generated. From this list, further testing is done (blood work, cultures, and/or biopsy) and interpreted, ideally producing a unique diagnosis. I differ from some of the posters in this thread that observe infection and necrosis in this patient. Infection of the skin (cellulitis) can appear red but is typically asymmetrical (affecting only one side, for example). In lymphedema, affected patients are prone to stasis dermatitis and lipodermatosclerosis, inflammatory conditions that are more common causes of redness than cellulitis in this population. Nevertheless, such patients are treated with antibiotics to no avail with alarming frequency. Necrotic skin has a black and sometimes ulcerated appearance not evident in the photo. ---
**Author:** ![susan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/susan/32/17537_2.png) [@susan](https://boards.straightdope.com/u/susan)\ **Post date:** [December 9, 2006, 5:23am UTC](https://boards.straightdope.com/t/what-disease-is-this-in-this-picture/383269/23 "2006-12-09T05:23:21Z")
> [@](#): > > In Wuchereria bancrofti infestation (the filarial etiologic agent of infectious elephantiasis) the organisms cause blockage of the lymphatic vessels producing marked lymphedema. I love it when you talk like that. ---
**Author:** ![Argent\_Towers](https://avatars.discourse-cdn.com/v4/letter/a/e8c25b/32.png) [@Argent\_Towers](https://boards.straightdope.com/u/Argent_Towers)\ **Post date:** [December 9, 2006, 6:42am UTC](https://boards.straightdope.com/t/what-disease-is-this-in-this-picture/383269/24 "2006-12-09T06:42:04Z")
These pictures in this thread are quite disgusting. What happens to these poor folks that get these awful disfigurements? Is there any kind of treatment for this stuff that work well? ---
**Author:** ![choosybeggar](https://avatars.discourse-cdn.com/v4/letter/c/8c91f0/32.png) [@choosybeggar](https://boards.straightdope.com/u/choosybeggar)\ **Post date:** [December 9, 2006, 6:59am UTC](https://boards.straightdope.com/t/what-disease-is-this-in-this-picture/383269/25 "2006-12-09T06:59:06Z")
[QUOTE=Argent Towers] These pictures in this thread are quite disgusting. What happens to these poor folks that get these awful disfigurements? Is there any kind of treatment for this stuff that work well? [/QUOTE] No effective treatment when the problem progresses to the extent shown in some of the photos. At an earlier stage, elastic garment compression helps considerably and prevents progression. ---
**Author:** ![choosybeggar](https://avatars.discourse-cdn.com/v4/letter/c/8c91f0/32.png) [@choosybeggar](https://boards.straightdope.com/u/choosybeggar)\ **Post date:** [December 9, 2006, 7:04am UTC](https://boards.straightdope.com/t/what-disease-is-this-in-this-picture/383269/26 "2006-12-09T07:04:18Z")
[QUOTE=Shoshana] I love it when you talk like that. [/QUOTE] I can’t be stopped! Stand back while I say [pityriasis lichenoides et varioliformis acuta.](http://dermatlas.org/derm/IndexDisplay.cfm?ImageID=1372146087) Do you want me to light your cigarette, darling? ---
**Author:** ![susan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/susan/32/17537_2.png) [@susan](https://boards.straightdope.com/u/susan)\ **Post date:** [December 9, 2006, 7:23am UTC](https://boards.straightdope.com/t/what-disease-is-this-in-this-picture/383269/27 "2006-12-09T07:23:21Z")
Oh, baby, you know smoking’s just _nasty._ ---
**Author:** ![choosybeggar](https://avatars.discourse-cdn.com/v4/letter/c/8c91f0/32.png) [@choosybeggar](https://boards.straightdope.com/u/choosybeggar)\ **Post date:** [December 9, 2006, 7:36am UTC](https://boards.straightdope.com/t/what-disease-is-this-in-this-picture/383269/28 "2006-12-09T07:36:43Z")
[QUOTE=Shoshana] Oh, baby, you know smoking’s just _nasty._ [/QUOTE] True, but if you do, I may say [thromboangiitis obliterans.](http://www.emedicine.com/med/topic253.htm)Trust me, it’s a turn on. 😃 ---
**Author:** ![susan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/susan/32/17537_2.png) [@susan](https://boards.straightdope.com/u/susan)\ **Post date:** [December 9, 2006, 7:40am UTC](https://boards.straightdope.com/t/what-disease-is-this-in-this-picture/383269/29 "2006-12-09T07:40:14Z")
I don’t know; I’m more of a Takayasu arteritis kind of girl, myself. ---
**Author:** ![diggleblop](https://avatars.discourse-cdn.com/v4/letter/d/ac91a4/32.png) [@diggleblop](https://boards.straightdope.com/u/diggleblop)\ **Post date:** [January 9, 2007, 5:49am UTC](https://boards.straightdope.com/t/what-disease-is-this-in-this-picture/383269/30 "2007-01-09T05:49:54Z")
[QUOTE=choosybeggar] No effective treatment when the problem progresses to the extent shown in some of the photos. At an earlier stage, elastic garment compression helps considerably and prevents progression. [/QUOTE] What about some sort of skin removal and then graphing techniques? ---
**Author:** ![choosybeggar](https://avatars.discourse-cdn.com/v4/letter/c/8c91f0/32.png) [@choosybeggar](https://boards.straightdope.com/u/choosybeggar)\ **Post date:** [January 9, 2007, 6:02am UTC](https://boards.straightdope.com/t/what-disease-is-this-in-this-picture/383269/31 "2007-01-09T06:02:18Z")
[QUOTE=diggleblop] What about some sort of skin removal and then graphing techniques? [/QUOTE] Nah, not a great option, Skin grafts require a hearty vascular bed for “take.” All that’s present in these end stage patients is fibrosis and poor vascularity. Grafting invites disaster. ---
**Author:** ![chorpler](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/chorpler/32/2888_2.png) [@chorpler](https://boards.straightdope.com/u/chorpler)\ **Post date:** [January 9, 2007, 5:16pm UTC](https://boards.straightdope.com/t/what-disease-is-this-in-this-picture/383269/32 "2007-01-09T17:16:39Z")
[QUOTE=Paul in Saudi] It could be an old, old photo of someone with Guinea Worm. It has been extinct for some time now. I am guessing from the number of lesions in the upper level of the skin. Or something else. [/QUOTE] Guinea worm isn’t extinct, but hopefully it’s well on its way. It’s one of those parasites that’s fairly easy to prevent – you just have to make sure your drinking water is filtered through some cheesecloth or something to catch the eggs, and keep infected people from putting their limbs in the drinking water supply to cool the burning sensation, until you’ve disrupted its life cycle long enough that it dies out in the area. Fortunately it has no animal hosts. ---
**Author:** ![chorpler](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/chorpler/32/2888_2.png) [@chorpler](https://boards.straightdope.com/u/chorpler)\ **Post date:** [January 9, 2007, 5:29pm UTC](https://boards.straightdope.com/t/what-disease-is-this-in-this-picture/383269/33 "2007-01-09T17:29:24Z")
[QUOTE=chorpler] Guinea worm isn’t extinct, but hopefully it’s well on its way. It’s one of those parasites that’s fairly easy to prevent – you just have to make sure your drinking water is filtered through some cheesecloth or something to catch the eggs, and keep infected people from putting their limbs in the drinking water supply to cool the burning sensation, until you’ve disrupted its life cycle long enough that it dies out in the area. Fortunately it has no animal hosts. [/QUOTE] Correction: you don’t filter guinea worm eggs, you filter the water fleas that have eaten the worm larva, because they grow in the water fleas until the fleas are consumed, at which point the fleas are dissolved by stomach acids and the larva go about their hideous work in the human body. Also, the Wikipedia article states that dogs can become infected, but I’ve seen other information that says guinea worms only infect humans. I’ll have to look into that further. ---
**Author:** ![Sapo](https://avatars.discourse-cdn.com/v4/letter/s/ec9cab/32.png) [@Sapo](https://boards.straightdope.com/u/Sapo)\ **Post date:** [January 9, 2007, 7:24pm UTC](https://boards.straightdope.com/t/what-disease-is-this-in-this-picture/383269/34 "2007-01-09T19:24:18Z")
It looks like “culebrilla”. I have no idea what that is called in english but the Guinea Worm is the closest of the ones offered. ---
**Author:** ![freckafree](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/freckafree/32/3050_2.png) [@freckafree](https://boards.straightdope.com/u/freckafree)\ **Post date:** [January 9, 2007, 8:04pm UTC](https://boards.straightdope.com/t/what-disease-is-this-in-this-picture/383269/35 "2007-01-09T20:04:02Z")
[QUOTE=Shoshana] I don’t know; I’m more of a Takayasu arteritis kind of girl, myself. [/QUOTE] Get a room, you two! Maybe a hospital room would be good. ---
**Author:** ![Absolute](https://avatars.discourse-cdn.com/v4/letter/a/b2d939/32.png) [@Absolute](https://boards.straightdope.com/u/Absolute)\ **Post date:** [January 9, 2007, 8:10pm UTC](https://boards.straightdope.com/t/what-disease-is-this-in-this-picture/383269/36 "2007-01-09T20:10:03Z")
Whatever the disease is, it still affects relatively wealthy people in the first world. I saw a woman in Radio Shack, driving a decent car, suffering from that condition (or something very similar, anyway). One of her legs was normal, and the other one looked exactly like the photo the OP posted. She was rather heavy-set, but other than her immensely bloated leg, not obese. It was like a 200-pound woman with the leg of a 500-pound woman attached. Her foot was swollen too large to fit in a shoe, so she was wearing one of those open-toed cloth medical shoes with the stiff heel. While she was wearing pants, I could see the texture of her skin, and as I said, exactly like the photo. I don’t mean to sound like I was gaping at the poor woman, I think I just took it all in in a glance. ---
**Author:** ![Absolute](https://avatars.discourse-cdn.com/v4/letter/a/b2d939/32.png) [@Absolute](https://boards.straightdope.com/u/Absolute)\ **Post date:** [January 9, 2007, 8:11pm UTC](https://boards.straightdope.com/t/what-disease-is-this-in-this-picture/383269/37 "2007-01-09T20:11:36Z")
Oh, and this was just a year or two ago, in an affluent suburb of Boston. ---
**Author:** ![choosybeggar](https://avatars.discourse-cdn.com/v4/letter/c/8c91f0/32.png) [@choosybeggar](https://boards.straightdope.com/u/choosybeggar)\ **Post date:** [January 10, 2007, 5:09am UTC](https://boards.straightdope.com/t/what-disease-is-this-in-this-picture/383269/38 "2007-01-10T05:09:51Z")
[QUOTE=Absolute] Whatever the disease is, it still affects relatively wealthy people in the first world. I saw a woman in Radio Shack, driving a decent car, suffering from that condition (or something very similar, anyway). One of her legs was normal, and the other one looked exactly like the photo the OP posted. She was rather heavy-set, but other than her immensely bloated leg, not obese. It was like a 200-pound woman with the leg of a 500-pound woman attached. Her foot was swollen too large to fit in a shoe, so she was wearing one of those open-toed cloth medical shoes with the stiff heel. While she was wearing pants, I could see the texture of her skin, and as I said, exactly like the photo. I don’t mean to sound like I was gaping at the poor woman, I think I just took it all in in a glance. [/QUOTE] See my post #22 for an explanation. In short, lymphedema = elephantiasis and there are many ways to get there one of which is Wuchereria bancrofti infestation. Clearly, it is exceeding unlikely that Radio Shack lady was infected with Wuchereria. Small quibble: Guinea worm (Dracuncula) infestation does not cause elephantiasis. [Previous page](https://boards.straightdope.com/t/what-disease-is-this-in-this-picture/383269.md?page=1)