Name of the Condition

• Gummata and ulcers of yaws; commonly referred to as yaws-related skin lesions.

Summary

• Gummata and ulcers of yaws are skin lesions resulting from a chronic bacterial infection caused by Treponema pallidum pertenue. Yaws primarily affects the skin, bones, and joints, and is most prevalent in warm, tropical regions.

Causes

• The condition is caused by the bacterium Treponema pallidum pertenue, which is transmitted through direct contact with the fluid from a lesion of an infected person.

Risk Factors

• Living in tropical regions with poor sanitation
• Close contact with an infected person
• Children aged 6–15 years are most commonly affected
• Poor access to healthcare services

Symptoms

• Round, thickened ulcers on the skin, commonly starting on the legs and feet
• Gummata, or nodular lesions, which can appear later in the disease
• Lesions can be painful and may lead to secondary bacterial infections

Diagnosis

• Clinical physical examination of skin lesions
• Serological tests such as the Rapid Plasma Reagin (RPR) test or the Venereal Disease Research Laboratory (VDRL) test
• Dark-field microscopy to identify the bacteria

Treatment Options

• Single-dose antibiotic treatment, typically with benzathine penicillin
• Alternative antibiotics for penicillin-allergic patients include azithromycin
• Proper wound care to facilitate healing

Prognosis and Follow-Up

• With appropriate antibiotic treatment, the prognosis is excellent, and healing occurs rapidly.
• Follow-up is essential to monitor and prevent recurrence, as well as to address any social or environmental conditions contributing to the spread of the infection.

Complications

• If untreated, yaws can lead to deformities in the bones and joints, chronic pain, and disability.
• Complicated ulcers may result in secondary infections.

Lifestyle & Prevention

• Improved hygiene and sanitation practices
• Community awareness campaigns to reduce stigma and encourage early treatment
• Mass drug administration programs in endemic regions

When to Seek Professional Help

• Persistent skin ulcers or nodules, especially if living in a yaws-endemic area
• Any signs of new skin lesions in someone previously treated for yaws

Additional Resources

• World Health Organization (WHO) initiatives for yaws eradication
• Centers for Disease Control and Prevention (CDC) informational resources
• Local health departments in endemic areas for community-level interventions

Tips for Medical Coders

• Ensure accurate documentation of both the primary yaws infection and any secondary symptoms such as ulcers or gummata.
• Double-check ICD code A66.4 for Gummata and ulcers of yaws to ensure correct classification and billing.
• Be aware of differential diagnoses that might mimic yaws-related lesions.