Topical exposure to arsenic used in vineyards and calcium compounds used as micronutrients (Chapter 14) are common causes of ulcerations in agriculture. The diagnosis is made by the characterized scalloped appearance of the skin, although a biopsy may be necessary to exclude other etiologies. Secondary infections may occur and may necessitate systemic or topical antibiotics. Treatment is by removal of the offending agent, wet dressings, and emollients (49).

Chronic skin ulcers caused by Mycobacterium ulcerans (Buruli ulcer disease) are common in people who work in aquatic environments such as rice paddies and fish farms. Snails transitorily harbor M. ulcerans (50).

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