The disease begins with a round, hard swelling of the skin, two to five centimeters in diameter. The center may break open and form an ulcer. This usually heals after three to six months. After several weeks, or even years later, the joints and bones may become painful, fatigue may develop, and new skin sores may appear. The skin of the palms of the hands and the soles of the feet may become thick and break open. The bones (especially those of the nose) may change shape. After five years or more large areas of skin can die. This leaves large scars.