A woman with nail changes

A 64 year old woman presented with two weeks of redness, pain, swelling, and exudation of the periungual skin around all fingernails and toenails. Examination found she had complete destruction over the nailfolds, and the periungual skin was erythematous with blisters (fig 1). Fig 1 Damage over the nail folds of finger and toenails She was treated for bacterial and fungal paronychia without any improvement, and the results of fungal microscopy and culture of periungual skin were negative. Two weeks later, she developed cutaneous blisters/bullae on the trunk, which were thinly walled and relatively flaccid. The rest of the skin became fragile, and light stroking caused the epidermis to …