© The Authors • Journal compilation © Blackwell Verlag GmbH, Berlin • JDDG • 1610-0379/2010/0801 JDDG |1 ˙ 2010 (Band 8) JDDG; 2010 • 8:7–13 Submitted: 11. 2. 2009 | Accepted: 16. 3. 2009 Keywords • geochemical tropical disease • Ethiopia • Uganda • secondary lymphoedema • non-filarial elephantiasis • aluminium silicate • volcanic soil Summary Podoconiosis or mossy foot is a form of non-filarial lymphedema. This geo- chemical elephantiasis is a disabling condition caused by the passage of microparticles of silica and aluminum silicates through the skin of people walk- ing barefoot in areas with a high content of soil of volcanic origin. Podoconiosis is widespread in tropical Africa, Central America and North India, yet it remains a neglected and under-researched condition. The disabling effects of podoco- niosis cause great hardship to patients. It adversely affects the economic (reduced productivity and absenteeism), social (marriage, education, etc.) and psychological (social stigma) well-being of those affected. Podoconiosis can be prevented; the main primary preventive measure is protective footwear. Secondary measures include a strict hygiene regimen and compression therapy, which can reverse initial lesions. Tertiary approaches include surgical management, such as shaving operations to reduce hyperplastic and verru- cous elephantiasis. Podoconiosis – non-filarial geochemical elephantiasis – a neglected tropical disease? Pietro Nenoff 1 , Jan Christoph Simon 2 , Grace K. Muylowa 3 , Gail Davey 4 (1) Laboratory for Medical Microbiology, Mölbis, Germany (2) Department of Dermatology, Venerology, and Allergology, University Clinic of Leipzig, Germany (3) Skin Clinic/Dept. of Dermatology, Mbarara University of Science and Technology, Uganda (4) School of Public Health, Addis Ababa University, Ethiopia Introduction Podoconiosis (Greek: podos, foot; ko- nion, dust), also known as “mossy foot” or Price’s disease (after E. W. Price who made a major contribution to the under- standing of the disorder as a separate en- tity in the 1970s and 1980s) is a non-in- fectious form of secondary lymphedema or elephantiasis, which is endemic in tropical regions. Podoconiosis occurs in tropical regions in people who walk bare- foot on clay or dusty volcanic soil. Mi- croparticles of silicon and aluminum sil- icate penetrate the skin of the lower extremities and enter the subcutaneous tissue, lymph vessels, and lymph nodes, causing inflammation and blocking lymph drainage. This results in second- ary lymphedema with elephantiasis which is barely distinguishable from in- fectious forms of elephantiasis [1]. Although podoconiosis, formerly also known as non-filarial elephantiasis, is found in many tropical countries, it re- ceives scant attention in dermatology textbooks and standard works on tropi- cal dermatology [2–5]. The title of a recent article in The Lancet by Davey & Newport [6] makes one pause: “Podoconiosis: the most neglected tropi- cal disease?” History Podoconiosis has been a known disease for more than 1 000 years. Descriptions of “swollen legs” can be traced back to the Romans, and in the year 905 a simi- lar description appears in a Tibetan translation from Sanskrit (the second book by rGyud-bzhi, “The Four Tantras”) [7]. The adventurer James Bruce wrote around 1770 about elephantiasis in Gondar in Northern Ethiopia: “The chief seat of this disease is from the bending of the knee downwards to the ankle; the leg is swelled to a great de- gree, becoming one size from bottom to top, and gathered into circular wrinkles … from between these circular divisions a great quantity of lymph constantly oozes. It should seem that the black colour of the skin, the thickness of the leg, its shapeless form and the rough tu- bercules or excrescences, very like those seen upon the elephant, gave the name to this disease …” DOI: 10.1111/j.1610-0387.2009.07099.x Review Article 7