Review Question - QID 108628

A 59-year-old man presents to the physician complaining of a blistering rash on his hands that comes and goes. At different times, the rash has affected his hands, legs, inguinal creases, and the corners of his mouth. His past medical history is significant for a blood clot in his left lower extremity. On further questioning, he admits that he has been feeling very depressed for the past few months even though there haven’t been any major changes in his life that he can think of that would have caused these feelings. On physical exam, temperature is 98.4°F (38.9°C), blood pressure is 118/75 mmHg, pulse is 65/min, and respirations are 12/min. He is slender and appears tired. His skin exam is remarkable for the findings shown in Figure A. His blood glucose is 280 mg/dL. Which of the following is the most likely diagnosis?