The Wound Nobody Wants to Talk About
Picture a wound on your leg that has been open for months. It does not heal. It may smell. And in some communities, neighbors assume it is a curse, a punishment, or a sign of poor hygiene.
So you cover it. You wait. You hope it goes away.
This is the reality for many patients with chronic skin ulcers in Burkina Faso, a landlocked West African nation facing poverty, limited healthcare infrastructure, and widespread beliefs that can make a physical wound feel like a social sentence.
Why This Study Matters Now
Chronic skin ulcers — wounds that fail to heal within three months — affect millions of people worldwide. In high-income countries, the most common causes are poor circulation and diabetes. In sub-Saharan Africa, the picture is more complex: infections, malnutrition, trauma, and diseases rarely seen elsewhere all play a role.
Burkina Faso has been under-studied for this condition. This review, spanning 11 years and two major university hospitals in the country's largest cities, is one of the most detailed looks yet at who is getting these wounds and what is causing them.
Old Assumptions, New Findings
The assumption in global health circles has long been that Buruli ulcer — a destructive skin infection caused by the bacterium Mycobacterium ulcerans — is primarily a rural disease, found in remote communities near slow-moving water. Urban centers were thought to be largely safe.
But here's the twist: half of the Buruli ulcer cases identified in this review were in Ouagadougou, the capital. That challenges the idea that urbanization protects against this disease.
This doesn't mean Buruli ulcer is spreading rapidly through cities, but it does suggest the boundaries of where the disease occurs are less clear than assumed.
Mycobacterium ulcerans produces a toxin called mycolactone that destroys fat and tissue without triggering the usual immune alarm bells — meaning the wound is often painless at first. Think of it like a slow leak under a wall: by the time you notice visible damage, the rot has already spread further than you can see.
Because it does not hurt in early stages, patients often do not seek care until the ulcer has grown large and disfiguring. The delay between first symptom and hospital visit is often months or even years.
Researchers reviewed consultation records from two university hospitals — Souro Sanou in Bobo-Dioulasso and Yalgado Ouedraogo in Ouagadougou — covering January 2013 to December 2023. They identified 104 patients treated for chronic skin ulcers over that period, averaging about nine patients per year. Most were adults (60 patients) or older adults (21 patients). Fifty-nine patients had leg ulcers specifically. Eight patients had confirmed Buruli ulcer.
The numbers are striking not for how large they are, but for how small. Nine patients per year across two major referral hospitals in a country of 23 million people almost certainly represents a fraction of the true burden.
Among the eight Buruli ulcer cases, five were children and teenagers under 19 years old. Three were adults. Half lived in the capital. These numbers suggest the disease is not confined to remote villages — and that children may be particularly vulnerable to late diagnosis because their symptoms can be mistaken for other common childhood infections.
That's Not the Full Story
The researchers are explicit: the low patient numbers reflect deep underreporting, not a low disease burden. Social stigma is the primary driver. Patients hide wounds for months or years before seeking care. Some never seek care at all, relying on traditional healers or simply waiting.
When patients do arrive at hospital, they often arrive late — with larger wounds, more complications, and harder treatment courses ahead.
If you or a family member has a skin wound that has not healed in three months, especially on the legs, see a doctor — even if the wound is not painful. In West Africa specifically, painless wounds that grow slowly may need to be tested for Buruli ulcer. Early diagnosis means simpler, shorter treatment with antibiotics rather than surgery.
If you are a healthcare provider working in West Africa, community outreach and non-judgmental language about chronic wounds could be the difference between a patient seeking care in week four or year four.
This study reviewed records from only two hospitals over 11 years, capturing 104 patients — a small sample that reflects only those who sought formal care. The study design (retrospective, meaning looking back at old records) limits what conclusions can be drawn. Causes of leg ulcers beyond Buruli ulcer were not broken down in detail, and stigma-related undercounting could not be directly measured.
The authors call for targeted community awareness campaigns that address the stigma around chronic wounds without reinforcing shame. They also recommend systematic screening programs that can reach patients who would otherwise never walk through a hospital door. As climate change shifts water patterns in West Africa, the geographic range of Mycobacterium ulcerans may expand — making surveillance in urban areas increasingly important. More research with wider geographic reach is needed to understand the true scale of this hidden problem.
