An otherwise healthy 16-year-old boy presented for evaluation of a painful, occasionally sweaty, plaque on his distal toe of the left foot for 1-year duration (Figure 1). He was previously treated with topical fusidic acid, bifonazole, and intravenous cefuroxime, without any improvement. The patient denied any history of gout, trauma, or insect bites. Physical examination revealed a tender edematous erythematous plaque on his left digitus minimus. Laboratory investigation including complete blood count, C reaction protein, and comprehensive metabolic panel was all within normal limits.A biopsy specimen was obtained for histopathologic analysis (Figure 2A-B).