FS01.4 Hailey Hailey disease – a significant hazard to consider when patch testing

Abstract

A 42 year old man was referred to the Contact Dermatitis Investigation Unit because of a 12 month history of an inflammatory eruption affecting his neck. He was patch tested to our standard series, textile series and his own medicaments. At the 48 hour reading the patches were removed and there were large areas of unusual painful superficial erosions where the patch test tape – Scanporä had been in contact with the skin. This appearance was difficult to explain. He denied interfering with the patches. The erosions were dressed with non‐adherent dressings held in place by a different tape‐ Microporeä. At the 96 hour reading these dressings were removed and in the areas under the Microporeä tape there were further erosions around the edge and also some thin walled vesicles and small bullae. There were ++ allergic reactions to sodium metabisulphite, disperse blue 35, 124 and 106 all of which were felt to be relevant as he had used Trimovateâ 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. Anti‐epidermal (skin) antibodieswere also negative. This striking and alarming clinical presentation after removal of patch tests had been encountered once previously in our Contact Dermatitis Investigation Unit. The possibility that the disorder was artefactual either due to an irritant introduced under the tapes or perhaps due to a contaminant within the tape adhesive was considered but no conclusion was reached In this case the clue to diagnosis became apparent at the second patch test reading when small vesicles and bullae could be seen at the edge of where the Microporeâ had been. A diagnosis of Hailey Hailey disease (HHD) trigered by the trauma caused by the adhesive tapes and their removal was made. The relatively persistent nature of his presenting problem makes Grover’s disease less likely. The affected sites healed after two weeks. Allergic contact dermatitis particularly to medicaments is reported to be a frequent complication and routine patch testing has been advocated1. There has been a previous report of blistering at the site of patch testing however he was an individual already known to have HHD2. Despite having patch tested around 30 000 people in the last 22 years this complication had not been encountered until this year. We present this case whose clinical features are distinctive as we feel similar instances may have been or will be seen by colleagues. Diagnosis may be difficult if there are no blisters in association with the painful erosions.