Iqbal Akhtar Khan.
Tropical Phagedena: A scar and a wound.
J Pak Assoc Derma Jan ;10(4):19-21.

Tropical phagedena (Syn: tropical phagedenic ulcer, tropical ulcer) is a disabling condition of the lower limb mainly affecting children and teenagers with predilection for males. It was previously limited to African countries but now its paws are expanding to Indian Subcontinent and Oceania. It may, at times, take the form of an epidemic, like that occurring in Cook Islands in early 1976. The old belief of its association with poor sanitation and malabsorption is no more tenable. At present, it is thought to be a polymicrobial infection with fusobacteria, aerobic microorganisms and spirochaetes each playing a role. The complications range from secondary infection to development of soft tissue sarcoma and squamous cell carcinoma. The latter is responsible for 20% of all lower limb amputations in Nigeria. A significant association between the scar and infection with hepatitis B virus has been documented in a Gambian study. The course of the disease can be interrupted by aggressive local treatment and systemic antibiotic therapy. Unfortunately, most lesions are recalcitrant and necessitate surgical excision. There is neither immunization nor chemoprophylaxis available. Significant protection can be obtained by behaviour modification, which is very well rewarding. A remarkable decrease in the incidence of squamous cell carcinoma of skin in the African region has been demonstrated by prevention of tropical ulcer.

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