The diagnosis and management of tropical ulcer in east Sepik Province of Papua New Guinea.

This survey, carried out in the East Sepik Province of Papua New Guinea, examined the prevalence of tropical ulcer, the accuracy of diagnosis and the methods of management. Most patients presenting with ulcerative skin lesions are treated in acid posts (219) and an estimated 7500 cases are seen annually out of a total rural population of 260,000. A sample survey suggested that of these only two-thirds meet diagnostic criteria for tropical ulcer, the rest being 'sores' or infected traumatic lesions. Standard primary therapy for all such lesions usually includes intramuscular penicillin and regular dressings with Eusol. All patients are seen on at least four occasions and hospitalized patients require a minimum of 15 days therapy compared to 10 days if lesions are grafted early. Skin grafting produces excellent responses but has a high 'drop-out' rate. There is a clear need for a uniform approach to the management of ulcerated skin lesions combined with ready access to grafting facilities to reduce the need for long-term dressings and the risk of chronic ulcerations.