A specific acute ulcerative skin disease

Cause

• Trauma followed by presence of fusiform bacilli and spirochetes (Vincent’s type)
• Common in people with malnutrition and poor hygiene

Clinical features

• Over 95% occurs in lower third of the leg

Stage 1:

• Trauma, painful swelling, blister with blood stained discharge leading to an oval lesion which spreads rapidly

Stage 2:

• Necrosis with yellowish/black sloughs which separate to form ulcer with raised and thickened edge. Floor has early bleeding granulations, and foul smelling yellowish discharge

Stage 3:

• Symptoms subside or may go into a chronic stage

Complications include

• Chronic tropical ulcer
• Cancellous osteoma (exostosis)
• Epithelioma
• Contracture

Differential diagnosis

• Buruli ulcer

Investigations

Swab for C&S
X-ray

Management HC2

Acute (all ages)

Clean the wound with chlorhexidine solution 0.05% or hydrogen peroxide solution 6%

Excise the necrotic edges

Elevate and rest the leg

Perform daily dressing

If not responding:

add PPF 800,000 IU IM once daily for 7-10 days child: 20,000 IU/kg per dose

Alternative in case of allergy to penicillin:(adults only)

doxycycline 100mg every 12 hours for 5 days

Chronic (all ages)
HC2

Give antibiotics as per C&S results

Where there are no facilities for C&S:

Give metronidazole 200mg every 8 hours for 5 days child: 35-50mg/kg per dose

plus cotrimoxazole 960mg every 12 hours for 5 days child: 24mg/kg per dose

Then do a skin graft

Prevention

• Ensure personal hygiene
• Ensure good nutrition
• Avoid trauma