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"Hi all~ I have a patient with an interesting case. I am not sure if I am approaching it from the right angle. Any & all feedback and suggestions are welcome and appreciated. Thanks!

Male, 51 yoa c/c: sores on toes, occurs every Feb. and lasts until around May. Has had this for 10+ years. These sores are painful, itchy, hot, irritated. They begin as small, light red circles about 1cm wide, and after about a week a small lighter center circle emerges (w/red border)- feels like a thorn is in the center. Then it fades away as does the itching/pn/irritation. As some are fading new ones are emerging. His doc has run numerous studies: biopsies, coagulation tests, circulation tests, all are (-). He has even been the subject of a specialty panel which consisted of several experts (mostly dermatologists) in Santa Barbara and no one knew what his condition was.

Symptom exacerbated when he had the flu a few weeks ago. In Feb, his demands at work are significantly..."