17 year old female presents to urgent care clinic with the following on her hands. It is non pruritic and is not painful. It appears after exposure to water or extreme activity. Patient is a competitive cheerleader and it commonly appears at practice. A scrape biopsy was done with the following path result. This is not my specialty (I picked up an extra float shift) and I’m very intrigued as to what could cause this! Differentials? Treatments?