A 58-year-old man presented with a pruritic rash on his left distal dorsal forearm that had been present for 3 months. It started after his wrist was exposed to paint. The patient had been treated with mupirocin ointment, ketoconazole cream, and desonide 0.05% cream (Desowen). After 3 months of unsuccessful treatment, clobetasol cream had been prescribed, and the rash worsened 1 week later. The patient had a history of untreated pedal onychomycosis and was immunocompetent.

Examination revealed discrete papules, pustules, and nodules coalescing into plaques. The rash was warm and erythematous, with tender scaling plaques and very fine pustules (Figure 1). Gram stain and culture of the pustules showed no bacteria nor growth.

QUESTION

Based on the patient's history and physical examination, which one of the following is the most likely diagnosis?

• A. Cellulitis.

• B. Impetiginized contact dermatitis.

• C. Majocchi granuloma.

• D. Methicillin-resistant Staphylococcus aureus folliculitis.

• E. Sporotrichosis.