A 37-year-old woman comes to the dermatologist with an increasingly painful rash on the palms of the hands and soles of the feet. She has no fever and is not sick. On the hands and feet, erythematous lesions and yellow fluid-filled vesicles to bullae are seen, usually oval in shape and running along the skin lines. In addition, she has a crusty rash around the nostrils. A few weeks later, 2 nails come off.
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