Tropical ulcer

Tropical ulcer
Synonyms	Aden ulcer, Jungle rot, Malabar ulcer, Tropical phagedena
The left foot of a person with acute tropical ulcer upon his admission to Toborra Goroka Hospital, in Goroka, New Guinea.
Classification and external resources
Specialty	dermatology
ICD-10	L98.4 (ILDS L98.440)
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Tropical ulcer is a chronic ulcerative skin lesion thought to be caused by polymicrobial infection with a variety of microorganisms, including mycobacteria. It is common in tropical climates.

Ulcers occur on exposed parts of the body, primarily on anterolateral aspect of the lower limbs and may erode muscles and tendons, and sometimes, the bones. These lesions may frequently develop on preexisting abrasions or sores sometimes beginning from a mere scratch.

The vast majority of the tropical ulcers occur below the knee, usually around the ankle. They may also occur on arms. They are often initiated by minor trauma, and subjects with poor nutrition are at higher risk. Once developed, the ulcer may become chronic and stable, but also it can run a destructive course with deep tissue invasion, osteitis, and risk of amputation. Unlike Buruli ulcer, tropical ulcers are very painful. Lesions begin with inflammatory papules that progress into vesicles and rupture with the formation of an ulcer. Chronic ulcers involve larger area and may eventually develop into squamous epithelioma after 10 years or more.

There is now considerable evidence to suggest that this disease is an infection. Mycobacterium ulcerans has recently been isolated from lesions and is unique to tropical ulcers. Early lesions may be colonized or infected by, Bacillus fusiformis (Vincent's organism), anaerobes and spirochaetes. Later, tropical ulcer may become infected with a variety of organisms, notably, staphylococci and/or . The condition has been shown to be transmissible by inoculation of material from affected patients.

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