Ulcus tropicum

Desert ulcer, Tropical ulcer, Tropical phagedena.

Special form of Ecthymata.

A disease that is particularly prevalent in the tropics.

• Intrusion of pathogens through small skin lesions
• Pathogens: Streptococci and staphylococci, gram-negative bacteria or Plaut Vincent organisms. Often secondary colonisation with fusospirillosis
• Predisposing factors: malnutrition, especially with protein deficiency
• Immune suppression

• Blood-filled bullae result from skin lesions, often after minor injuries. After incision, a necrotic base is visible, which often extends to the subcutaneous tissue, sometimes even deeper to the facia or the muscles and periosteum.
• In addition, extremely pronounced scarring with dermatogenous contractures requiring amputations have been described in the healing process.

• Anamnesis
• Clinic
• Bact. smear

V.a. distal lower legs.

• Early antibiotic therapy is essential
• Recurrences are possible

Topical therapy

• Moist, antiseptic poultices

Systemic therapy

• PenicillinG i.v. 4 million IU 6x tgl.
• PenicillinV p.o. 3x t.d. 0.4-1.2 million IU (adults), 0.2-0.6 million IU 1x t.d. (infants) for approx. 10 days
• Erythromycin p.o. 500 mg 3x tgl., maximum dose: 4 g/d (adults), 40-100 mg/kg
• Gentamicin i.v. 5 mg/kg bw
• Ciprofloxacin p.o 500 mg 2x tgl.

Surgical intervention if necessary.

Adaptive nutrition.

1. Adriaans B, Hay R, Drasar B , Robinson D. The infectious aetiology of tropical ulcer—a study of the role of anaerobic bacteria. Br J Dermatol 1987;116:31-7.
2. MacDonald P. Tropical ulcers: a condition still hidden from the Western world. Journal of Wound Care 2003;12:85-90.
3. Meyers WM , Portaels F. Mycobacterium ulcerans Infection (Buruli Ulcer). Tropical Infectious Diseases: Elsevier BV; 2006. p. 428-35.
4. Na. Protozoa in a Case of Tropical Ulcer (Delhi Sore). The American Journal of the Medical Sciences 1904;127:938.