Do you recognize this pustular rash in an elderly female?

​Figure 1.
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An 80-year-old female with a history of arthritis and high blood pressure presents with recurrent lesions and erythema on the palms of her hands and the soles of her feet. On examination, hyperkeratosis, brown macules, and discrete pustules are seen on her palmoplantar surfaces. A fungal culture and serologic tests are unremarkable. Which of the following is most strongly associated with this patient’s condition?

A) Exposure to ultraviolet radiation
B) Prior HPV infection
C) History of cigarette smoking
D) Prior aspergillus exposure

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