A 28-year-old female presents with recurrent episodes of intensely pruritic, deep-seated vesicles and bullae on the lateral aspects of her fingers, palms, and soles. The lesions often appear in clusters and are associated with a burning sensation. She reports that stress and warm weather exacerbate her condition. What is the most likely diagnosis?

Explanation

The description of recurrent, intensely pruritic, deep-seated vesicles and bullae on the lateral aspects of the fingers, palms, and soles, often appearing in clusters and exacerbated by stress or warm weather, is classic for dyshidrotic eczema, also known as pompholyx. The term 'dyshidrotic' is a misnomer as it's not related to sweat gland dysfunction, but the clinical picture is highly characteristic. B. Pustular psoriasis presents with sterile pustules on an erythematous base, often more widespread or localized to palms/soles (palmoplantar pustulosis), but the primary lesions are pustules, not deep-seated vesicles/bullae, and it's typically less intensely pruritic in the same way as dyshidrotic eczema. C. Scabies presents with intensely pruritic papules, vesicles, and burrows, typically in web spaces of fingers, wrists, axillae, and genitalia. While pruritic, the morphology and distribution are different. D. Hand-foot-and-mouth disease is a viral infection (Coxsackievirus) causing fever, oral ulcers, and vesicular rash on hands and feet, primarily in children. The vesicles are usually smaller, less deep-seated, and the systemic symptoms and epidemiology differ.