what do you think this is? Patient presented to | Figure 1

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what do you think this is?

Patient presented to my office today with these patches/open areas on her fingers. She states that it has been present for several months, and just as she feels it clears up the fingers will open again and become painful. It has not responded to moisturizers or topical steroids. She states that there is nothing new in her home, environment, or beauty products. What do you think it is and how would you advise to treat?

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