History:

A young adult woman has had long history (about 8 years) of recurrent red succulent plaques with irregular border (rocky-island pattern) and sometimes had illusion of vesiculation - look vesicular but are solid when pressed i.e. pseudovesicular appearance. The plaques chiefly involved the face and forearms with few occasional lesions on the upper trunk. She had no prodromal symptoms, oral lesions, or associated underlying condition (e.g. drugs, inflamatory bowel disease, CTD or mailgnancy). On investigations, the WBC count was normal, however skin biopsy was consistent with Sweet's syndrome and showed distinctive band of subepidermal edema with band-like infiltrate rich in neutrophils with nuclear dust and ingestion of neutrophils by macrophages (bean bag cells). Prednisolone in a dose of 15-20 mg per day usually give dramatic response within few days (see the last image), however on stopping treatment recurrences were the rule with variable periods od rmissions.