How do you explain these pruritic papules?

Case 4:

For the past 2 weeks, a 32-year-old woman has noticed itchy bumps on her right hand. She is a stay-at-home mother of 2 young children; her hands are frequently in water. The patient applied a miconazole cream for a few days, but to no avail. She is otherwise healthy and takes no medications.

What condition are you looking at here?

A.  Dyshidrosis.
B.  Pompholyx.
C.  Candidiasis.
D.  Dermatophyte infection.
E.  Contact dermatitis.

(Answer on next page.)

A potassium hydroxide evaluation revealed the dermatophyte infection, tinea manuum, D. The evaluation also ruled out contact dermatitis and dyshidrosis (another name for pompholyx, a self-limited, eczematous reaction). Candida responds to miconazole, whereas a dermatophyte is more resistant to that medication.