Generalized pustular psoriasis after renal transplantation-failure to suppress with cyclosporin A

There are now several reports describing the beneficial effects of oral cyclosporin A (CyA) therapy in widespread plaque psoriasis1-4 and a single report of generalized pustular psoriasis of the von Zumbusch variety responding to CyA.5 We report a patient who developed generalized pustular psoriasis provoked by rapid corticosteroid withdrawal after renal transplantation. At the onset of the eruption whole blood CyA levels were above the post-renal transplant therapeutic range. Management options for pustular psoriasis developing after renal transplantation are discussed.