Current Therapeutic Strategies for Buruli Ulcer

The skin is a multifaceted organ with varied functions, but its exposure to various environmental conditions, including exposure to ultraviolet light, trauma, and infections, makes it more prone to ulcers. Ageing, poor lifestyle, and certain diseases, like obesity, hypertension, diabetes, etc., further exaggerate the cause. Skin ulcers are wounds (sores) often caused by reduced blood flow leading to absolute loss of the epidermal layer along with parts of the dermis or subcutaneous fat, and thus have tremendously slow healing affinity. Buruli ulcer (BU), or Bairnsdale is a type of necrotizing skin ulcer mainly caused by the bacterium, Mycobacterium ulcerans, and characterized initially by the formation of papules or nodules (edematous lesions), which further progresses to chronic skin ulceration as a result of epidermal hyperplasia, collagen destruction, and vascular damage in the underlying dermis and subcutis. It is considered one of the 20 neglected diseases of the skin by the World Health Organization (WHO). Although scattered in more than 33 countries, its prevalence is the highest in West Africa and this incidence has risen manifold during the last few years, which might be due to deforestation, artificial topographic alterations, and increased manual agriculture. Mycolactone, a polyketide-based immunosuppressive macrolide, is considered the major factor responsible for the pathogenesis of the disease. Its high toxicity dampens the immune system, causing extensive tissue destruction mainly in skin cells and minute blood vessels, leading to ulceration and skin loss. Generally, a combination of rifampicin with streptomycin, amikacin, clarithromycin, or ciprofloxacin along with oral prednisolone for eight weeks is specified as a first-line treatment. Surgery to remove necrotic tissue, BCG vaccination for short-term protection, and physiotherapy to promote healing are also found beneficial. To combat this deadly disease, enhanced public education and awareness through outreach initiatives is a must as prevention is always considered better than cure. Further studies in this area may be helpful in investigating more treatment regimens along with various ways by which the occurrence of Buruli ulcer can be avoided. The present study is therefore designed to compile all relevant literature, which can serve as an important lead for further investigations in this area of research.