Patchy, Erythematous, Pruritic Rash

A 58-year-old African American man presents as a referral for the evaluation of a patchy, erythematous, pruritic rash that is primarily on his trunk and legs.

Patchy, Erythematous, Pruritic Rash

The rash has been present for about 20 years and has expanded progressively from initially involving his lower back and buttock to spreading to his legs and upper back.

Previous biopsies have been performed, which showed a possible contact dermatitis. He was also treated with numerous antifungal shampoos and creams, but showed no improvement.

On examination, there are numerous eczematous erythematous patches and plaques on the back, chest, arms and legs, involving approximately 75% of the patient’s total body surface area

What is the most likely diagnosis ?