Nodule
The lesion starts as a small subcutaneous swelling which is barely palpable but not visible. It gradually increases in size until the skin is slightly raised. The nodule is firm with a regular margin and is attached to skin but is not attached to the deep fascia.As the lesion enlarges it involves the deep fascia and then extends in this layer . At this stage the edges are less distinct owing to an intervening layer of normal tissue. The skin overlying the lesion tends to desquamate,leaving a shiny surface which often appears darker than normal. Later the skin over the centre of the lesion loses its pigmentation, becomes necrotic, and eventually ulcerates. In some lesions a small central vesicle develops, which may be broken to exude a small amount of clear fluid. The burst vesicle may progress to an ulcer or it may heal.
BURULI: In this disease it is important to recognize the right moment for starting with a Phage Therapy treatment.
Top: Early nodular lesion.
Center/bottom:Deep and undermined ulcerative lesion with necrotic borders, before and after medical treatment plus local surgery including skin grafting.
This figure appears in color here
