Buruli ulcer

Role of specific antibiotics in Mycobacterium ulcerans (Buruli ulcer) management

Provisional guidelines

Case definitions3


A painless, raised skin lesion, less than 1 cm in diameter. The surrounding skin is reddened. Papules are commonly seen in Australia.


A lesion that extends from the skin into the subcutaneous tissue and is 1–2 cm in diameter. It is usually painless but may be itchy, and the surrounding skin may be discoloured compared with adjacent areas. Nodules are commonly seen in Africa.


A firm, painless, elevated, well-demarcated lesion more than 2 cm in diameter with irregular edges. The skin over the lesion is often reddened or otherwise discoloured.

Oedematous form

Diffuse, extensive, usually non-pitting swelling. The affected area has ill-defined margins, is firm and painless and involves part or all of a limb or other part of the body. There may be colour changes over the affected area and the disease may be accompanied by fever.

Ulcerative forms

When fully developed, the ulcer has undermined edges and is indurated peripherally. The floor of the ulcer may have a white, cotton wool-like appearance due to necrotic slough. The ulcer is usually painless unless there is secondary bacterial infection. When there is more than one ulcer and the ulcers are close together, they often communicate beneath intact skin.

Disseminated or mixed forms

Simultaneous presence of different forms of the disease including bone and joint involvement in the same patient.

New case

A new case is defined as a patient with no previous history of or treatment for M. ulcerans disease.

Recurrent case

A patient with previous surgical (and/or antibiotic) treatment for M. ulcerans who presents with another lesion or lesions at the same or different site within one year of the end of the last treatment.

3 Source: (24).