Mutational analysis in familial and sporadic patients with white sponge naevus

that the pustular reaction in our patient was not an irritant reaction. Herbal medications, which are major components of complementary and alternative medicines, are easily accessible and have become increasingly popular worldwide, and healthy people as well as patients with chronic illness take herbal medicines as part of health-seeking behaviours. Consequently, they have emerged as significant causes of adverse drug reactions such as toxic hepatitis or drug eruption in recent years. A major concern is that it is not always possible to know what exactly is contained in herbal remedies; even though we can identify the contents in some cases, it is still often not clear whether the causative agent of the drug eruption is some constituent of the herbs or a synthetic chemical, heavy metal or possible contaminant contained in the herbal medication. Velvet antler is known to have anti-inflammatory, antineoplastic, immune-stimulatory and growth-promoting effects and to contain several amino acids, alkaline earth metals and other minerals. Although we also could not establish which substance was responsible for the generalized pustular eruption in our patient, velvet antler must be the culprit of the AGEP because the skin eruption developed after taking it without any underlying medical conditions and the patch test revealed a positive reaction; our case might necessitate a more specific approach to the research into the safety of herbal remedies. In conclusion, we present a unique case of AGEP induced by taking velvet antler. Herbal medicines such as velvet antler should always be considered as a cause of drug eruption including AGEP. Dermatologists should be familiar with the cutaneous adverse effects of herbal medicines as well as conventional medicines and a thorough history taking is mandatory when considering a patient with suspected drug eruption.