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Chapter 36

Tropical Ulcers

Many children and adults who live in the tropics suffer from skin and subcutaneous ulceration, particularly on their legs and feet. There are many different causes, but one variety, the true "tropical ulcer", is responsible for a great deal of acute and chronic ill health. If such ulcers are untreated, a few become malignant, yet, if they are recognized early, they can be cured. With education they can be easily prevented. Such ulcers have been recorded for many years; for example, by missionary doctors treating slaves as they walked across what is now Tanzania towards the coast in 1880. An even earlier report concerned a Dutch ship in 1775. There is little doubt that tropical ulcers must have occurred wherever there was poor hygiene and wounds were neglected. Because of the introduction of Western clothing, particularly trousers and boots which protect the legs, tropical ulcers are decreasing in frequency, but they still remain a considerable health problem in many parts of the world.


Tropical ulcer. Zambesi ulcer. Rhodesia sore. Tropical phagedenic ulcer. Ulcus tropicum. Aden ulcer. Malabar ulcer. Naga sore (India). Cochin sore. Natal sore. Delgaoa sore. Kidonda ndugu (Swahili). Mozambique sore. Madi sore. Yemen ulcer. Mango ulcer. Annamite sore.

Sp: Ulcera trófica or tropical. Fr: Ulcère trophique or tropical. Sarmes du Congo. Ger: Geschwür tropisches.

"Tropical ulcers" are not the same as the veldt sore, desert sore, Barcoo rot, Castellani's ulcer, tropicaloid ulcer, sickle cell ulcer, Buruli ulcer, or myobacterial ulcer. These are summarized at the end of this section.


A tropical ulcer is an acute, specific, localized necrosis of the skin and subcutaneous tissues which is endemic in, but not confined to, tropical regions.

After the acute stage, a chronic phagedenic (spreading) ulcer may persist and penetrate the deep fascia to directly involve tendons and occasionally bones. In the acute spreading stage the ulcers are invariably infected with Bacillus fusiformis, but later many other organisms may be cultured.

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