This is a 29 year old female I saw after she developed spont | Figure 1

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This is a 29 year old female I saw after she developed spontaneous erythema of her great toe-not to this extent. I treated her for paronychia. Since I saw her she has seen multiple providers and has been on multiple antibiotics, topical antifungals, topical and oral steroids and had the toenail removed. She has consulted with podiatry and dermatology. Dermatology sent her back to family practice and I am unsure what to do next. This is painful, has been present for 10 months and is worse. Neither podiatry or derm think it is fungal. Steroids didn’t change it. PMH: lichen planus, Raynauds, fibromyalgia and acne. Meds: cymbalta, aldactone and naproxen. She is not diabetic. She wears nail polish daily for the past 10 years. Next step?

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