**8. Paradoxical reactions in BU treatment**

Paradoxical reaction in the healing process has also been reported [91]. This describes a stage where instead of the ulcers healing during antibiotic treatment, it rather becomes worst [91]. The exact mechanism underlining paradoxical reaction in BU healing is poorly understood. It has been speculated that immediate restoration of cytokine response to *M. ulcerans* antigens after mycolactone wash out could be the plausible explanation.
