Tips
- Continuous local heating to 40°C by circulating water jackets promotes healing, even without excision.
- Hyperbaric oxygen may also be useful.
- Physical therapy is important when the patient is at risk for contractures.
- BCG vaccination may lead to limited protection for a short period.
Plan for treatment
| Category I | less than 5 cm in diameter | antibiotics alone |
| Category II | 5-15 cm in diameter | 4 wks antibiotics then surgery then 4 wks antibiotics |
| Category II | more than 15 cm in diameter | One wk at least antibiotics then surgery then complete 8 wks antibiotics |
Medical treatment
- Oral rifampicin 10 mg/kg and intramuscular streptomycin 15 mg/kg should be given daily for 8 weeks.
- Rifampacin 10 mg/kg and amikacin 15 mg/kg should be given for 8 weeks.
- Rifampicin and clarithromycin (7.5 mg/kg) should be given for 8 weeks or rifapentine plus moxifloxacin for 8 weeks.
Surgical treatment
- Surgery should be considered in addition after 4 weeks for category II lesions and after 1 week for category III lesions
- Large ulcers often require skin grafts or rarely amputation.
Notes
- Immune reconstitution inflammatory syndrome: recognized clinically by deterioration after initial improvement and may be treated with corticosteroids.