Tropical Phagedenic Ulcer (Vincent's Ulcer)

Abstract

Summary 1. Tropical phagedenic ulcer is a distinct entity with a characteristic appearance. It occurs on the lower extremity as a large rounded ulcer with undermined edges, and is filled with a wet gangrenous slough, in which fusiform bacilli and spirochetes predominate in the bacterial flora. 2. If inadequately treated, the lesion may persist as a chronic ulcer with a hard fibrosed base and border. In this stage there are no longer any bacteriologic or histopathologic features which distinguish it from other indolent ulcers. It is important, from the standpoint of both prognosis and therapy, to differentiate between the acute phagedenic ulcer and the chronic non-specific ulcer. 3. Other diseases to be considered in differential diagnosis are: desert sore, cutaneous diphtheria, pyogenic ecthyma, cutaneous leishmaniasis, syphilitic gummata, and other rarer ulcerative lesions. 4. The geographic distribution of the disease is presented. 5. The etiology is discussed. The preponderance of evidence to date indicates that the ulcers are caused by Vincent's fusospirochetes in a host who has become susceptible to infection as a result of a vitamin B deficiency, and who is possibly further debilitated by chronic disease and general malnutrition. 6. The successful treatment of Vincent's infections of the mouth: gingivitis, angina, and noma with penicillin is recorded. The superb results of other investigators and of the author in treating the active phase of tropical phagedenic ulcers with penicillin indicates that it will probably become the treatment of choice. The chronic stage should be treated surgically.