Rash NYD | Figure 1

Rash NYD

71yo F with IBS and prior shingles, otherwise healthy presenting with these almost vasculitic rashes going on for 3 months. Symmetric distribution involving mid umbilical region, as well as upper/lower extremities. Highly pruritic, did not respond to high potency topical steroid or PO Prednisone, a punch biopsy was done which revealed "sparse perivascular lymphocytic infiltrate" and negative for fungal staining. Given a somewhat suspicious distribution we also empirically treated for scabies but with no response.

Any further advice is appreciated.