|Clinical Guidelines and Treatment Manual (Médecins Sans Frontières, 1993)|
|Chapter 4 - Skin conditions|
Erosive lesion of the skin, usually occurring on the lower leg caused by:
- vascular (venous and/or arterial) insufficiency,
- bacterial or parasitic infection,
- underlying metabolic disorders.
Phadegenic ulcers have no apparent cause, they extend and become chronic.
- Clean with chlorhexidine-cetrimide or chloramin solutions (dilution: see table 25).
- Excise necrotic edges.
- Daily dressing.
- Rest with leg elevated.
- Give oral antibiotics if local treatment fails:
Adult: 2.4 MIU/d divided in 3 doses x 5 days
Child: 100,000 IU/kg/d divided in 3 doses x 5 days
If no improvement, give:
erythromicin (PO): 50 mg/kg/d divided in 3 doses x 7 days
- Skin graft if ulcer is large. Only graft after local treatment has rendered it clean and flat with red granulation tissue in the base.
- Think of Guinea worm in endemic zones.
- Give tetanus toxoid .