CRP and Hyperkeratosis: CRP: 70 mg/L ESR: 100 mm/hr  Skin Biopsy: Epidermis shows Epidermis shows hyperkeratosis, focal neutrophilic crust over stratum corneum, basal cell vacuolation, perivascular infiltrates  ANA: Negative  IgA: >595 mg/dL  IgM: 89 mg/dL  IgE: 8,856 mg/dL CD3/CD19/CD56: normal  NBT /TH17/STAT3: normal