Classical Sweet's syndrome
A 38-year-old female presented with red raised, painful lesions on right forearm with fever since 10 days, which gradually coalesced to form larger lesions []. Patient had similar episodes 3 years back which had subsided on taking some medications. There was a prior history of upper respiratory tract infection. On examination, patient was febrile. A large erythematous plaque of size 8 × 6 cm was present on right upper extremity. Small erythematous plaques were also present on both upper limbs, right side of neck, and chest. Few lesions showed typical “relief of mountain range appearance”. Local temperature was raised in all the lesions. Superficial nerves were not thickened and sensations on the plaques were normal. All other investigations were within normal limits apart from elevated ESR. Histopathology showed a diffuse infiltrate consisting predominantly of mature neutrophils located in the upper dermis without evidence of primary leukocytoclastic vasculitis []. Our patient was initially treated with tablet dapsone 100 mg HS with dramatic early improvement and relapse on discontinuation. The second episode was treated with a combination of dapsone and oral prednisolone started at 30 mg/day and gradually tapered over 4 weeks. The patient is now in remission [].