Treatment with gefitinib (ZD 1839) in a patient with advanced cutaneous squamous cell carcinoma

pore tape there were further erosions around the edge and also some thin-walled vesicles and small bullae. There were ++ allergic reactions to sodium metabisulphite and disperse blue 35, 124 and 106, all of which were felt to be relevant as he had used Trimovate cream and regularly wore dark nylon clothing when refereeing lacrosse matches. A biopsy was taken for histology and immunofluorescence from an area of blistering. This demonstrated suprabasal acantholysis with vesicle formation. There were occasional corps ronds. The immunofluorescence was negative. Antiepidermal (skin) antibodies were also negative. A diagnosis was made of HHD triggered by the trauma caused by the adhesive tapes and their removal. This striking and alarming clinical presentation after removal of patch tests had been encountered once previously in our Contact Dermatitis Investigation Unit. Patient 2, a 66-year-old man with a diagnosis of eczema since his twenties, had developed reactions under adhesive dressings over the previous 12 months. He was patch tested to our standard series, the acrylic adhesive series and his own medicaments. At the 48-h reading there were areas of erosions at the edges of the patch test tapes, and these were photographed at the end of patch testing (Fig. 1b). They were dressed with Melolin and mupirocin ointment. He had + allergic reactions to balsam of Peru and Daktacort cream. The possibility was considered that the disorder was artefactual, either due to an irritant introduced under the tapes or perhaps due to a contaminant within the tape adhesive, but no conclusion was reached. Following the diagnosis of patient 1 we reviewed him and a further assessment was made. We considered HHD in the differential diagnosis of the erosions. A solitary erythematous plaque was noted in his left axilla. A biopsy was taken and this demonstrated suprabasal acantholysis consistent with HHD. The immunofluorescence was negative. These two patients were both labelled as having eczema until the highly unusual patch test appearances were investigated and HHD serendipitously diagnosed. HHD can induce painful extensive erosions as a result of patch testing. The affected patch test sites in our patients healed after 2 weeks. The relatively persistent nature of the presenting problem makes Grover’s disease less likely. Interestingly, both these individuals had had problems under adhesive dressings. HHD therefore needs to be considered when investigating individuals with a history of reactions under adhesive dressings. Allergic contact dermatitis particularly to medicaments is reported to be a frequent problem in HHD and routine patch testing has been advocated. There has been one previous report of blistering at the site of patch testing but in an individual already known to have HHD. Despite having patch tested around 30 000 people in the last 22 years this complication had not been encountered until this year. We present these cases with distinctive clinical features as we feel it is possible that similar instances may have been or will be seen by colleagues. The diagnosis may be particularly difficult when there are no blisters.