Veld sore.—Under the name of Veld sore we have a form of tropical ulcer which is common in various desert regions.
These ulcerations may appear on the face as well as on the dorsal surfaces of the hands or forearms or on the lower extremities. They seem to arise from infections of abrasions of the exposed parts. In the early stages of the lesion the diphtheria bacillus has been frequently isolated and some of the cases have been followed by diphtheritic palsies. It would appear that these lesions have at times been those of cutaneous diphtheria. Such cases were reported by Craig in cases in the Sinai desert. The simultaneous existence of cases of ordinary faucial diphtheria should make one suspicious of the real nature of such ulcerations. Skin diphtheria is more frequent than is generally considered.
Symptomatology
These ulcers are most frequently found on the dorsum of the foot, over the shin and about the external malleolus. More rarely they involve the dorsum of the hand or back of the wrist.
In the multiplicity of clinical descriptions from various parts of the tropics we obtain two types of ulceration.
One is that of a rather chronic ulcer, which slowly develops from a painless swelling, which is not unlike a gummatous process. Surrounding the swelling there is a circumscribed, reddened, glazed area of skin. After two or three weeks the swelling begins to soften and a serous fluid exudes from its summit.
Ulceration, with the frequent formation of a membrane-like deposit, now sets in and later on we have a more or less punched-out ulcer showing indurated margins. There may be no impairment in the health of those with this type of ulcer.
The other type is generally seen in persons who are much debilitated or suffering from some cachectic state. In the earliest stages these sores seem to resemble an area which has been excoriated and inoculated with vaccine virus, there being a rather dry, angry-looking spot of erythema. This within a few hours may be surrounded by a circle of vesicles beyond which is an encircling inflammatory areola.
There is marked subjective pain and tenderness. The serum from the vesicles fails to show any bacteria and the cellular contents are made up almost entirely of polymorphonuclear leucocytes. Within a few hours to one or two days the area within the ring of vesicles is converted into a dark gray to black pultaceous diphtheroid membrane which when detached shows underlying fungating granulations, covered with greenish-yellow pus. This membrane, if stripped off, tends to reform with great rapidity (twenty-four to forty-eight hours), and in many respects resembles the membrane of diphtheria except for its dark color.
These ulcerations extend with great rapidity and even when showing a tendency to heal may suddenly, from a point along the margin, proceed to form a new area of ulceration, extending somewhat as would a ringworm. When the original site of ulceration fails to heal during a period of several weeks, the edges become rather indurated but do not show the punched-out or undermined characteristics of the first type.