Can you identify this condition?

A 39-year-old white man presents with a 4-week history of extremely pruritic papular lesions that started on his hands. Itching is most intense at night, whereas during the daytime the pruritus is tolerable but persistent. He has a history of eczema, and he applied some hydrocortisone cream with minimal improvement. He notes that shortly after starting the cream the eruption spread to his groin. He denies any recent changes in personal hygiene products, including laundry detergents. He was recently released from prison and had started a new job at a bottle depot.

Examination reveals dozens of 2- to 5-mm erythematous papules involving the finger web spaces, wrists, lower abdomen, and groin. Minimal scaling was observed.

The most likely diagnosis is

1. Atopic dermatitis

2. Insect bite reaction

3. Contact dermatitis

4. Scabies

5. Dermatitis herpetiformis

Answer on page 854

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