This document summarizes several specific types of ulcers, including their causes, characteristic features, locations, investigations, and treatments. It discusses tuberculous ulcers, syphilitic ulcers, chancroid ulcers, actinomycosis ulcers, Meleney's ulcer, and Bairnsdale ulcer. For each type of ulcer, it provides details on etiology, appearance, distinguishing characteristics, affected body sites, diagnostic tests, and management approaches.

1. SPECIFIC ULCERS
DR.SUNIL KAMBLE
ASSISTANT PROFESSOR
DEPT.OF GEN.SURGERY
MNR MEDICAL COLLEGE,SANGAREDDY

2. • Tuberculous ulcer
• Syphilitic ulcers
• Soft chancre or chancroid (Ducrey’s)
• Actinomycosis
• Meleney’s ulcer
• Bairnsdale ulcer

3. TUBERCULOUS ULCER
Develop due to bursting of cold abscess.
1.from matted tuberculous lymph node
2.from tb of bone or joint
3.from subcutaneous lesions
eg.intestinal tb
tongue tb

4. CHARCTERISTIC FEATURES
• Size &shape
oval in shape with irregular crescenteric
border
• No.-multiple
• Edge-reddish blue & undermined
• Depth-shallow
• Pain-slight

5. • Floor-pale granulation tissue with slight
discharge
• Base-slight induration indicates
chronicity.base usually will be
Lymph node
bone
joint

6. LUPUS VULGARIS (WOLF)
• Form of cutaneous tb,occurs commonly in the
face & hand
• Common in children & young adults.
• Starts very superficially
• Peculiarity-heals at the centre and remains
active at the periphery & thus gradually
spreads like a wolf.

7. MANAGEMENT OF LV
• Antitubercular drugs
• Excision
• STSG

8. INVESTIGATIONS
• Chest x-ray
• ESR
• Examination of discharge
• Biopsy

9. SYPHILITIC ULCERS
• Seen in 3 stages
Primary syphilis
• Hard chancre or Huntarian chancre is seen
• Usually develops at the site of entry of
treponomes in 3-4 weeks of exposure.
• Sites-
genitalia

10. • Lip
• Tongue
• Nipple
• Perianal region

11. CHARACTERISTIC FEATURES
• Single
• Painless
• Indurated base which feels like a button
• Shalllow oval or round in shape with raised
hyperaemic margin
• Regional lymph nodes enlarged,firm,discrete
& painless.

12. SECONDARY SYPHILIS
• Ulcers may develop in the form of mucous
patches,snail track ulcers or condylomas
• Mucous patches-
white patches of sodden thickened epithelium
• Snail-track ulcers-
• multiple small,round & superficial erosions which
coalesce to form narrow,curved shallow
ulcers……..
• Common in mouth

13. Condyloma lata
• Fleshy wart like growths mostly seen at
mucocutaneous junctions
• Angles of mouth
• Anus
• Vulva
• Epitrochlear & suboccipital group of lymph nodes
enlarged.

14. TERTIARY SYPHILIS
• Gumma or gummatous ulcer
• Gumma is a syphilitic hypersensitivity reaction
consisting of granulation tissue with central
necrosis.
• Sloughing of this tissue produces gummatous
ulcer-punched-out indolent edge &
painlessness.

15. • Floor-yellowish grey gummatous tissue (wash
leather slough)
• On healing leaves ‘tissue paper’ scar
• WR Kahn & VDRL tests positive

16. Sites
1.subcutaneous bones-
Tibia
Ulna
Skull
• 2 scrotum
• 3 tongue

17. SOFT CHANCRE/CHANCROID
(DUCREY’S)
• Gram negative Hemophillus Ducreyi
• Contagious disease
• 3-5 days after exposure-sores on genitalia
• Painful
• Become pustular & ulcerate to form soft sores
Ulcers
• multiple

18. • Rounded
• Soft
• Painful
• Readily bleed
• Undermined edges
Regional lymph nodes enlarged

19. TREATMENT
• Sulphonamide
• Cotrimoxazole
• 2 tabs twice daily for 7-10 days

20. ACTINOMYCOSIS
• Multiple ulcers
• Indurated
• Nodules appear, which soften & ulcerate in
various places
• Surrounding skin looks bluish

21. DIAGNOSIS
• Sulphur granules from pus
• Microscopy- gram positive mycelia
(actinomyces israelii)
Sites-
• Fascio-cervical
• Thorax
• Right iliac fossa
• liver

22. MELENEY’S ULCER
• Post operative wounds either after surgery for
perforated viscus or drainage of empyema
thoracis.
• Dorsum of hand
• Due to symbiotic reaction of microaerophilic
non-hemolytic streptococci & hemolytic staph
aureus

23. BAIRNSDALE ULCER
• Caused by acid fast Bacilli-Mycobacterium
ulcerans
• Deep severe form is called Buruli ulcer with
extensive dermal necrosis
• Diagnosis-afb
• Rx- anti Tb drugs
• STSG

24. THANK YOU