Thick, leathery and red skin over the hands

A 10-year-old Hispanic girl presented with a rash that had been present for four months. Previous treatment with topical corticosteroids for atopic dermatitis provided no resolution of the rash. Examination of the hands revealed erythematous lichenified plaques distributed over the joints, along with ragged cuticles and periungual telangiectasias.



In addition, violaceous patches with areas of hypo- and hyperpigmentation along with telangiectasias ...