Ulcers in Hot Climate Zones

  • Federica Dassoni


Skin ulcers are a common problem in the Western world, where most ulcers localized on the legs are due to venous insufficiency, arterial disease, neuropathies (usually diabetic), malignancies, or combinations of those. In addition, physicians may be consulted for imported skin ulcers because of the increasing travels to exotic locations. The prevalence of leg ulcers in hot climate zones is largely unknown; there have been no studies on large series. The most common causes for ulcers in a global perspective are thought to be infections, including pyoderma, mycobacterial infections, tropical ulcer, diphtheria, anthrax, and others. In some parts of the world, cutaneous leishmaniasis is one of the most prevalent causes; this is also one of the ten most frequent causes of skin diseases in travelers returning from tropical countries.


  1. 1.
    Gupta SK, Shukla VK. Leg ulcers in the tropics. Int J Low Extrem Wounds. 2002;1:58–61.CrossRefPubMedGoogle Scholar
  2. 2.
    Ziegelaar JE, Faber WR. Imported tropical infectious ulcers in travelers. Am J Clin Dermatol. 2008;9:219–32.CrossRefGoogle Scholar
  3. 3.
    Webb J, Murdoch DA. Tropical ulcers after sports injuries. Lancet. 1992;339(8785):129–30.CrossRefPubMedGoogle Scholar
  4. 4.
    Veraldi S, Caputo R. Dermatologia di importazione. 2nd ed. Milan: Poletto Editore; 2000. p. 108–10.Google Scholar
  5. 5.
    Adriaans B, Drasar BS. The isolation of fusobacteria from tropical ulcers. Epidemiol Infect. 1987;99:361–72.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Adriaans B. Tropical ulcer—a reappraisal based on recent work. Trans R Soc Trop Med Hyg. 1988;82:185.CrossRefPubMedGoogle Scholar
  7. 7.
    Robinson DC, Adriaans B, Hay RJ, et al. The clinical and epidemiologic features of tropical ulcer (tropical phagedenic ulcer). Int J Dermatol. 1988;27:49–53.CrossRefPubMedGoogle Scholar
  8. 8.
    Spencer H, et al. Tropical pathology. Berlin: Springer; 1973. p. 706.Google Scholar
  9. 9.
    Walsh DS, Meyers WM, Portaels F. Buruli ulcer. In: Faber WR, Hay JR, Naafs B, editors. Imported skin diseases. 2nd ed. New York: Wiley-Blackwell; 2013. p. 94–106.Google Scholar
  10. 10.
    Marsollier L, Robert R, Aubry J, et al. Aquatic insects as a vector for Mycobacterium ulcerans. Appl Environ Microbiol. 68:4623–8.
  11. 11.
    Benbow ME, Williamson H, Kimbirauskas R, et al. Aquatic invertebrates as unlikely vectors of Buruli ulcer disease. Emerg Infect Dis. 2008;14:1247–54.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Phanzu DM, Mahema RL, Suykerbuyk P, et al. Mycobacterium ulcerans infection (Buruli ulcer) on the face: a comparative analysis of 13 clinically suspected cases from the Democratic Republic of Congo. Am J Trop Med Hyg. 2011;85:1100–5.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Vincent QB, Ardant MF, Marsollier L, et al. HIV infection and Buruli ulcer in Africa. Lancet Infect Dis. 2014;14:796–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Toutous Trellu L, Nkemenang P, Comte E, et al. Differential diagnosis of skin ulcers in a mycobacterium ulcerans endemic area: data from a prospective study in Cameroon. PLoS Negl Trop Dis. 2016;10:e0004385.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    WHO. Provisional guidance on the role of specific antibiotics in the management of Mycobacterium ulcerans disease (Buruli ulcer). Geneva: WHO; 2004.Google Scholar
  16. 16.
    Etuaful S, Carbonnelle B, Grosset J, et al. Efficacy of the combination rifampin-streptomycin in preventing growth of mycobacterium ulcerans in early lesions of Buruli ulcer in humans. Antimicrob Agents Chemother. 2005;49:3182–6.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Nienhuis WA, Stienstra Y, Thompson WA, et al. Antimicrobial treatment for early, limited mycobacterium ulcerans infection: a randomised controlled trial. Lancet. 2010;375:664–72.CrossRefPubMedGoogle Scholar
  18. 18.
    Chauty A, Ardant MF, Marsollier L, et al. Oral treatment for mycobacterium ulcerans infection : results from a pilot study in Benin. Clin Inf Dis. 2011;52:94–6.CrossRefGoogle Scholar
  19. 19.
    Weatherall DJ, Clegg JB. Inherited haemoglobin disorders: an increasing global health problem. Bull World Health Organ. 2001;79:704–12.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Grosse SD, Odame I, Atrash HK, et al. Sickle cell disease in Africa. A neglected cause of early childhood mortality. Am J Prev Med. 2011;41:S398–405.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Modell B, Darlison M. Global epidemiology of haemoglobin disorders and derived service indicators. Bull World Health Organ. 2008;86:417–96.Google Scholar
  22. 22.
    Minniti CP, Eckman J, Sebastiani P, et al. Leg ulcers in sickle cell disease. Am J Hematol. 2010;85:831–3.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Delaney KM, Axelrod KC, Buscetta A, et al. Leg ulcers in sickle cell disease: current patterns and practices. Hemoglobin. 2013;37:325–32.CrossRefPubMedGoogle Scholar
  24. 24.
    Wethers DL, Ramirez GM, Koshy M, et al. Accelerated healing of chronic sickle-cell ulcers treated with RGD peptide matrix. RGD Study Group. Blood. 1994;84:1775–9.PubMedGoogle Scholar
  25. 25.
    Okany CC, Atimomo CE, Akinyanju OO. Efficacy of natural honey in the healing of leg ulcers in sickle cell anaemia. Niger Postgrad Med J. 2004;11:179–81.PubMedGoogle Scholar
  26. 26.
    Ndiaye M, Niang SO, Diop A, et al. Leg ulcers in sickle cell disease: a retrospective study of 40 cases. Ann Dermatol Venerol. 2016;143:103–7.CrossRefGoogle Scholar
  27. 27.
    Enwonwu CO, Falkler WA, Phillips RS. Noma (cancrum oris). Lancet. 2006;368(9530):147–56.CrossRefPubMedGoogle Scholar
  28. 28.
    Tonna JE, Lewin MR, Mensh B. A case and review of noma. PLoS Negl Trop Dis. 2010;4:e869.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Baratti-Mayer D, Gayet-Ageron A, Hugonnet S, et al. Risk factors for noma disease: a 6-year, prospective, matched case-control study in Niger. Lancet Glob Health. 2013;1:e87–96.CrossRefPubMedGoogle Scholar
  30. 30.
    Chiandussi S, Luzzati R, Tirelli G, et al. Cancrum oris in developed countries. Aging Clin Exp Res. 2009;21:475–7.CrossRefPubMedGoogle Scholar
  31. 31.
    Marck KW. Noma: a neglected enigma. Lancet Glob Health. 2013;1:e58–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Ashok N, Tarakji B, Darwish S, et al. A review on noma: a recent update. Glob J Health Sci. 2015;8:53–9.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Masipa JN, Baloyi AM, Khammissa RA, et al. Noma (cancrum oris): a report of a case in a young AIDS patient with review of pathogenesis. Head Neck Pathol. 2013;7:188–92.CrossRefPubMedGoogle Scholar
  34. 34.
    Bolivar I, Whiteson K, Stadelmann B, et al. Bacterial diversity in oral samples of children in Niger with acute noma, acute necrotizing gingivitis, and healthy controls. PLoS Negl Trop Dis. 2012;6:e1556.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Huyghe A, Francois P, Mombelli A, et al. Microarray analysis of microbiota of gingival lesions in noma patients. PLoS Negl Trop Dis. 2013;7:e2453.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Federica Dassoni
    • 1
  1. 1.Ospedale Alessandro Manzoni di LeccoCentro Medico SantagostinoMilanoItaly

Personalised recommendations