Tropical ulcer--a reappraisal based on recent work.

Tropical ulcer is a disease which predominantly affects young children in the tropics. The course of the disease can be interrupted in the early stages by the administration of antibiotics so it seems likely that infection may play a role. The disease extends rapidly from the initial lesion, a tiny papule, to a large area of necrosis. This makes a toxic factor likely in the pathogenesis. The epidemiology and some of the causative factors of this disease are currently being investigated. Patients with tropical ulcers were assessed, in areas where the disease is still endemic (Gambia, Papua New Guinea, southern India and Fiji), by a paediatrician or a dermatologist. All patients had swabs taken from the ulcers for bacteriological examination. Skin biopsies were taken from the edge of the ulcers as often as possible. The bacteriological samples were transported anaerobically to London where the laboratory work was performed. The results are discussed in relation to previously reported work.