28 yr old female with a 10 yr history of red hands

    28 year old womang with a history of Prader-Willi syndrome, history of raynaud's disease complains of a 10 year history of red hands with intermittent episodes of redness, heat, and swelling.  

    On exam, the pt has erythematous plaques on the hands and soles of feet with thin skin, fine scale, and superficial desquamation. The patient is currently taking Depakote, Topamax, and Lexapro.