Ulcus tropicum

Last Updated: 2021-10-15

Author(s): -

Desert ulcer, tropical ulcer, tropical ulcer, tropical phagedena.

Special form of Ecthymata.

A disease that occurs particularly in the tropics.

  • Penetration of the pathogens by small skin injuries.
  • Pathogens: streptococci and staphylococci, gram-negative bacteria or plaut-vincent organisms. Often secondary colonisation with fusospirillosis.
  • Predisposing factors: malnutrition, especially with protein deficiency.

  • Immunosuppression.
  • Skin lesions, often after minor injuries, result in blood-filled bullae. After incision a necrotic ground is visible, which often reaches the subcutaneous tissue, sometimes even deeper down to the fascia or the muscles and periosteum.
  • In addition, extremely pronounced scarring with dermatogenic contractures is described in the healing process, which requires amputations.

  • Medical history 
  • Clinic
  • Bacterial smear 

Especially distal lower legs.

  • Early antibiotic therapy is essential.
  • Recurrences are possible.

Systemic Therapy 

  • PenicillinG i.v. 4 million IU 6x daily.

  • PenicillinV p.o. 3x daily 0.4-1.2 million IU (adults), 0.2-0.6 million IU 1x daily (infants) for about 10 days.

  • Erythromycin p.o. 500 mg 3x daily, maximum dose: 4 g/d (adults), 40-100 mg/kg

  • Gentamicin intravenously 5 mg/kg bw 

  • Ciprofloxacin p.o 500 mg 2x daily.

 

Topical Therapy 

  • Moist, antiseptic envelopes e.g.: Lavasept®-Lsg. or Octenisept®-Lsg.

 

Surgical intervention, if necessary.

Adequate 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.