A diagnostic conundrum

This one is for doctors only

A couple of weeks ago at a remote coastal village I saw a sprightly 6 year old lad. His mother gave a 3 week history of mildly tender ulcers on his leg. He was running around, afebrile and with no inguinal adenopathy. I was flummoxed. I sent this picture to various Australian colleagues but they had no strong diagnostic insights.

I next copied the picture for Dr John Vince, professor of paediatrics at UPNG. I first met John at Port Moresby General Hospital in 1976 and he has been serving PNG ever since.

This where local knowledge comes in. John knew immediately what it was.

Have you got any ideas? I will put the answer in the next post.

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