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History

A 50 year old woman presented with a 6 week history of a rash which appeared first over her scalp and face before extending widely over the trunk and limbs. There was an orange-red, mildly scaling rash, confluent over much of the skin but with islands of sparing. In other areas there were follicular papules, and thickening of the palmar and plantar skin was noted. She complained of feeling cold and shivering and had a tachycardia, but was normotensive and afebrile. There was no history of previous rashes or medical illness. She had taken no medication.