A 44-year-old Caucasian woman presents with a six-year history of persistent itchy excoriations, and erythematous pruritic papules and plaques affecting both hands, especially on the dorsal aspects.

This has previously been diagnosed as psoriasis, and at that time, she was prescribed topical hydrocortisone with minimal improvement.

She is otherwise well. On examination, she has mild digital oedema with erythematous papules (pictured).

Dermatological examination is otherwise unremarkable