The correct answer is A. Prednisone.

Prednisone is the most appropriate initial treatment for neutrophilic dermatosis of the dorsal hands.

The examinee is presented with the image of an eroded violaceous plaque on the dorsal hand that is highly consistent with neutrophilic dermatosis of the dorsal hands, an entity combining clinical and pathologic features of Sweet’s syndrome and pyoderma gangrenosum. Prednisone (choice 1) is the most appropriate first-line treatment. While the remaining options (choices 2-5) have been used as second-line and beyond treatment of Sweet’s syndrome and/or pyoderma gangrenosum, none of them represents the most appropriate first-line therapy.

References:

Nelson CA, Stephen S, Ashchyan HJ, et al. Neutrophilic dermatoses: Pathogenesis, Sweet syndrome, neutrophilic eccrine hidradenitis, and Behçet disease. J Am Acad Dermatol. 2018 Dec;79(6):987-1006.

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