A woman with erythema and pustules

A woman in her 60s presented with a one week history of widespread erythema accompanied by pustules, scales, and mild itching. The lesions had started on the right side of her back and had spread to her trunk and limbs within two days. On examination, disseminated erythematous maculas with superficial scales and flaccid blisters filled with pus were seen (fig 1). She also had subungual hyperkeratosis and discolouration of the nail plate (fig 2). She received a diagnosis of pustular psoriasis and was treated with topical steroids, but her symptoms did not improve.