They are often initiated by minor trauma, and subjects with poor nutrition are at higher risk. Once developed, the ulcer may become chronic and stable, but also it can run a destructive course with deep tissue invasion, osteitis, and risk of amputation. Unlike Buruli ulcer, tropical ulcers are very painful.[4] Lesions begin with inflammatory papules that progress into vesicles and rupture with the formation of an ulcer.[1] Chronic ulcers involve larger area and may eventually develop into squamous epithelioma after 10 years or more.[5]