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Tropical ulcer (tropical phagedenic ulcer)

Tropical ulcer mainly occurs in children and teenagers, but is seldom seen in developed countries. It is patchily distributed in endemic foci throughout Africa, India and the West Pacific. It is associated with humid regions or areas subject to local flooding.

Tropical ulcer is considered to result from synergistic bacterial infection, of which one anaerobic organism is usually Fusobacterium ulcerans. Other bacteria present in lesions include spiral bacteria and Gram-negative bacteria.

F. ulcerans has also been isolated from mud and stagnant water in the vicinity of cases.

The initial lesion is a soft papule with surrounding hyper-pigmentation overlying an area of skin necrosis. This develops over at least 1 week, and when the overlying skin sloughs a regular and deep ulcer, 3–10 cm in diameter, is revealed.





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