Buruli Ulcer

Overview

Buruli ulcer is a skin infection caused by a type of bacteria called Mycobacterium ulcerans. The bacteria release a toxin that destroys skin and deeper tissue, usually forming a large, painless sore.

Buruli ulcer is rare in most of the world, but it is a public health concern in some tropical areas, especially in communities with limited access to clean water and healthcare.

Anyone can get Buruli ulcer, but in affected areas it most commonly affects children between 5 and 15 years old. It can also affect adults, especially those who work near rivers or wetlands.

Symptoms

Common symptoms

• A painless, firm lump (nodule) that may look like an insect bite
• A large, painless ulcer with raised edges and dead skin underneath
• Swelling and hardening of the skin around the sore
• The ulcer slowly grows over weeks or months without causing pain

Symptoms in children

• Ulcers commonly appear on the arms or legs
• Children may not complain of pain, even when the ulcer is large
• Parents may first notice a swollen, warm area or a change in skin color

Symptoms in older adults

• The ulcer may be more extensive or deeper
• Healing can be slower, and there may be more tissue damage
• Older adults may be more likely to have joint stiffness nearby

Causes

Main causes

• Buruli ulcer is caused by the bacterium Mycobacterium ulcerans.
• The bacteria produce a toxin that damages skin, fat, and sometimes deeper tissues.
• The exact way the bacteria spread to humans is not fully known, but it may be linked to water and slow-moving waterways in affected regions.

Risk factors

• Living in or traveling to tropical or subtropical areas where Buruli ulcer is found
• Having cuts, scratches, or open wounds that come into contact with contaminated water or soil
• Limited access to clean water and sanitation
• Living in an area with poor healthcare infrastructure

When to see a doctor

See a doctor urgently if:

• Any ulcer with spreading redness, increasing pain, or foul-smelling discharge
• A fever that comes with a skin ulcer
• A sore that grows noticeably larger over a few days

Book a routine appointment if:

• Any painless lump, swelling, or skin sore that lasts more than two weeks
• A slow-growing ulcer you cannot explain
• An old wound that does not heal despite good care

Diagnosis

A doctor will examine the sore and ask about your history, including travel to places where Buruli ulcer is found. To confirm the cause, laboratory tests are needed.

Tests that may be done

• PCR (polymerase chain reaction) test — a sensitive test that detects the bacteria's DNA
• Biopsy — a tiny sample of tissue from the ulcer is taken and checked under a microscope
• Culture — a sample is placed in a special medium to see if the bacteria grow
• Swab — fluid from the ulcer is collected and sent to the lab

What to expect at your appointment

The doctor will gently clean and examine the ulcer. Taking a sample may cause brief discomfort, but it is usually quick. You may need to wait days or weeks for lab results. While waiting, you may be asked to keep the wound covered and clean.

Treatment

Buruli ulcer is treated with a long course of antibiotics combined with careful wound care. Some people also need surgery. Starting treatment early gives the best chance of healing with minimal disability.

Self-care at home

• Keep the wound clean and covered with a sterile dressing as instructed
• Follow your healthcare provider’s advice about changing dressings and cleaning the sore
• Do not try to remove dead skin or tissue yourself
• Protect the ulcer from further injury and insect bites

Medical treatments

The main treatment is a combination of antibiotics taken over several weeks or months. Antibiotic therapy is effective in most cases and helps reduce the size of the ulcer even before surgery. Your doctor will also focus on pain control, wound dressing, and preventing or treating secondary infections. If needed, physical therapy can help you regain movement and strength.

When is surgery considered?

Surgery may be used to remove dead tissue, clean the wound, repair skin, or improve movement and appearance after healing. In current practice, surgery is often delayed until antibiotics have finished, unless the ulcer is deep or life-threatening.

Living with this condition

Treatment for Buruli ulcer can last for weeks or months. It is important to attend all follow-up visits, continue wound care at home, and watch for signs of new complications. Many people need dressing changes or physiotherapy during recovery.

Lifestyle tips

• Protect the affected area from pressure, friction, and injury
• Keep follow-up appointments even if the sore seems to be healing
• Follow your physiotherapist’s instructions to avoid joint stiffness or contractures
• Rest often and elevate the affected limb if it swells

Diet and exercise

Eating a balanced diet rich in protein and vitamins helps the body repair tissue. Staying hydrated also supports healing. Light, doctor-approved exercise can maintain joint flexibility, but avoid high-impact activity on the affected area until healed.

Mental health and emotional wellbeing

Living with a long-lasting, visible ulcer can be stressful and upsetting. You may feel anxious, embarrassed, or low in mood. These feelings are normal, and it helps to talk openly with your healthcare team, family, or a counselor.

Prevention

It is not always possible to prevent Buruli ulcer because the exact mode of transmission is not fully known. However, you can reduce your risk by protecting wounds, cleaning cuts immediately with soap and clean water, and covering skin in high-risk areas.

Vaccines

There is currently no vaccine to prevent Buruli ulcer.

Screening programmes

There is no routine screening test. In areas where Buruli ulcer is common, regular skin checks and prompt reporting of any unusual sore can lead to earlier diagnosis and better outcomes.

Complications

If left untreated

• Large, deep ulcers that destroy skin and soft tissue
• Permanent disfigurement or disability, especially around joints
• Infection of the bone (osteomyelitis)
• Blood infection (sepsis), which can be life-threatening

Long-term outlook

With early treatment, most people recover fully and can return to normal activities. Even more advanced ulcers can often be cured, though they may leave scars, changes in skin color, or some lasting stiffness. Seeking care early gives the best chance for a smooth recovery and a good final result.

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