Hi @seniormed thank you for your response, I really appreciate it!

I was actually gluten free for about 7 years (2013-2020) but did not add in antiinflammatory diet because I have been told by some of my physicians that it is anecdotal and there is not enough supported evidence of efficacy. My primary care (whom I really like and believe is well-educated and stays up to date) is an advocate of the anti-inflammatory diet as well. In my food sensitivity testing back in 2011 (IGG) I was moderately sensitive to gluten, but wasn't sure how much stock to put in that sort of testing. I did merit a call from a testing company physician from my results, because they told me I was one of the most "reactive" people they'd seen., with several "severe" sensitivities to different foods. As I said to @cpd54 I do have a gastrointestinal component in addition to these skin "flares" of reflux and diarrhea. I was diagnosed with gastroparesis as a teen after an EGD due to severe reflux causing weight loss at 12 years old. I was put on propulsid (and a PPI) but taken off due to it being pulled by the FDA due to mortality risk, I believe. I am on a PPI now which generally controls these symptoms outside of flares.

The advice on documentation is excellent and I am going to look back through my phone for any and all pictures I have available as that's an area I could improve upon. Most of my doctors are in the same health system so thankfully have easy access to each others notes.

I was trialed on colchicine for possible Behcet's but couldn't stay on any dose due to pretty severe diarrhea (I think I tried 1.2 mg all the way down to .3 mg). I know that's a common response, but my rheumatologist thought it was worth trying. My immunologist said I have non-allergic rhinitis and posited I am sensitive to physical particles, dust, smells (perfumes, gasoline, etc ) and put me on Flonase, which I tolerate decently though I do get epistaxis so have to monitor humidity/moisture levels carefully in the dry season. He did diagnose me as "high risk of infections" and I had my pneumococcal 23-valent vaccine early (< 65) because my titers were not robust enough for his liking. My primary care said we could consider steroids or antibiotics, but would think going the MAB route might have better response, but none of my specialists will discuss putting me on one because of lack of a specific diagnosis and my primary care says it's outside her scope of practice. I use hibaclens for the dermatitis aspect but my dermatologist didn't give me insight beyond "some people just get bacterial skin infections chronically."

We are definitely considering reaching out to Mayo again and also our state's well-known teaching hospital for some more evaluation and treatment plan.

Thanks again for all the advice and knowledge!