Rare cutaneous side‐effect of gefitinib masquerading as superficial dermatophytosis

crystal microembolization in small blood vessels. Some investigators have suggested that warfarin disrupts healing in ulcerated atherosclerotic plaques with release of cholesterol fragments. As a consequence, dermal arterioles are occluded, producing ischaemic infarction of the epidermis with local oxygen desaturation of blood and concomitant cyanosis. Despite the lack of apparent sequelae following our patient s knee surgery, we consider that there could be subclinical impairment of venous ⁄ lymphatic outflow from her left lower leg, which might explain the unilateral distribution of the phenomenon in this case. It may also favour a direct toxic aetiology for warfarin-induced purple toes, as local surgery is unlikely to affect cholesterol crystal microembolization. Management of the disorder involves withdrawal of warfarin, although this may not always be possible due to the presence of various risk factors. In conclusion, we report a rare adverse manifestation of warfarin therapy, purple toes syndrome, and to our knowledge, this is the first reported case of unilateral involvement associated with warfarin.