The correct answer is C. Thalidomide.

The question describes actinic prurigo, which is a rare pruritic photodermatitis with crusted papules and nodules predominantly on uncovered skin.  It is most common for indigenous people, especially Mestizos. It is more common in girls and usually presents in childhood and resolves in adolescence, though it may persist. Cheilitis, especially of the lower lip, and conjunctivitis are common. Rigorous photoprotection is important, and while topical steroids can help mild cases, thalidomide is used in refractory cases (50-100 mg nightly until resolved, then 50 mg every 2-3 nights for maintenance).

Hydroxychloroquine is used to treat a variety of conditions, including discoid and systemic lupus erythematosus, porphyria cutanea tarda, and psoriatic arthritis. Emollients may be used to manage mild atopic dermatitis, while topical tacrolimus and pimecrolimus creams are used to treat moderate to severe atopic dermatitis. Serial phlebotomy is beneficial in the iron overload in porphyria cutanea tarda.

ReferencesL Valbuena MC, Muvdi S, Lim HW: Actinic prurigo.Dermatol Clin 2014; 32: pp. 335-344.

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