The lesions are most suspicious for cutaneous leishmaniasis, possibly with a sporotrichoid pattern of multiple crusted or ulcerated nodules along the lower leg.

This cannot be diagnosed reliably from a photograph alone. Important alternatives include bacterial ecthyma, sporotrichosis, atypical mycobacterial infection, insect-bite reactions, and other chronic ulcerating skin conditions.

A dermatologist, infectious-disease, or tropical-medicine clinician should examine it soon. Confirmation usually requires a sample from the active raised edge of a lesion for skin smear/microscopy, PCR, culture, or biopsy. The WHO clinical factsheet notes that cutaneous leishmaniasis can begin as a papule and progress to an indolent ulcerated nodule or plaque, but requires parasitological confirmation.

Seek urgent care today if there is fever, rapidly spreading redness, severe pain, increasing swelling, pus, red streaking, or diabetes/immunosuppression. Avoid picking lesions or self-treating with steroid creams until assessed.