History:

A 26-year-old female planing to marry within next few months presented with red scaly rash mainly on the trunk and extremities except the palms and soles of 3 months duration. At last 3 weeks the rash exacerbated and associated with fever, headache, lassitude and arthralgia. 

The condition started with plaque psoriasis not exceeding more than 3% of the body surface area for which topical steroid was enough to fade away the lesions within 3-4 weeks. However, all of a sudden it recurred after stoppage of the treatment by the patient herself with larger number, size and extent of rash for which systemic CS (20 mg prednisolone per day) was prescribed by an unwise dermatologist !!!! Rapid response was obtained within 3 weeks and again she stopped her treatment to be followed by severe bout of widespread PUSTULAR PSORIASIS involved most of the trunk and major parts of the extremities. We admitted the patient to the hospital giving I.V fluid, systemic antibiotics and advice the patient to apply liberal amounts of emollients as her skin was so dry and tender at presentation. We arranged for CBC, ESR, S. electrolytes, liver function tests, renal function tests and Serum Ca. Two days later, we started Sandimmun syrup (Cyclosporine-A) at a dose of 5 mg per day in 2 divided doses with dramatic response within 3 days as most lakes of pus and individual putsutes had dried up (exfoliated). Within 5 days the patient discharged home in a stable good state on Cyclosporine only. One month later with great stabilization and improvement the dose reduced to a maintenance of 2.5 mg per day with monthly monitoring of renal function tests (specially S. creatinine) and serum electrolytes and frequent measurements of BP.