To the Editor: Systemic agents, including cyclosporine A (CsA), are used widely in the management of moderate to severe plaque psoriasis. CsA, indicated for use in patients with severe disease who are not immunocompromised, is effective largely in controlling psoriasis by reducing the surface area, erythema, induration, and desquamation of psoriatic plaques. 1 Lebwohl M. Ellis C. Gottlieb A. Koo J. Krueger G. Linden K. et al. Cyclosporine consensus conference: with emphasis on the treatment of psoriasis. J Am Acad Dermatol. 1998; 39: 464-475 Abstract Full Text Full Text PDF PubMed Scopus (158) Google Scholar However, because of associations with toxicity, patients receiving CsA must be monitored closely for potential adverse events, and long-term use is not recommended. 2 Yamauchi P.S. Rizk D. Kormeili T. Patnaik R. Lowe N.J. Current systemic therapies for psoriasis: where are we now?. J Am Acad Dermatol. 2003; 49: S66-S77 Abstract Full Text Full Text PDF PubMed Scopus (56) Google Scholar Adverse events associated with the use of CsA include nephrotoxicity, hypertension, elevation of lipids (cholesterol and triglycerides), and gastrointestinal disorders (nausea, vomiting, anorexia, and diarrhea). Headaches, myalgias, arthralgias, paresthesias, hyperesthesia, influenzalike symptoms, and fatigue can occur. Hypertrichosis and gingival hypertrophy, as well as acneiform eruptions and keratosis pilaris, are well-known dermatologic side effects. CsA also has been associated with the induction of various forms of malignancies such as lymphoproliferative disorders and skin cancers in transplant patients. 3 Srivastava T. Zwick D.L. Rothberg P.G. Warady B.A. Posttransplant lymphoproliferative disorder in pediatric renal transplantation. Pediatr Nephrol. 1999; 13: 748-754 Crossref PubMed Scopus (75) Google Scholar , 4 Hojo M. Morimoto T. Maluccio M. Asano T. Morimoto K. Lagman M. et al. Cyclosporine induces cancer progression by a cell-autonomous mechanism. Nature. 1999; 397: 530-534 Crossref PubMed Scopus (962) Google Scholar