A non-healing ulcerating lip lesion

A healthy 4-year-old child presented with a 9-month history of a non-resolving lip lesion. His family are Afghani refugees who transited through Pakistan prior to arrival to Canada 8 months earlier. The lesion began as a painless, erythematous papule with a punched-out appearance while he was in Pakistan. The lesion slowly grew and developed a painful central ulceration and intermittent bleeding (Figure 1). He had seen numerous Canadian physicians and received numerous topical and systemic antibiotics without improvement.

source https://www.jpeds.com/article/S0022-3476(23)00224-X/fulltext?rss=yes