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Clinical Images  |   October 2016
Porphyria Cutanea Tarda
Author Notes
  • From the UnityPoint Clinic in the Grundy County Memorial Hospital in Grundy Center, Iowa (Dr Neverman), and the Department of Medicine at the University of Missouri in Columbia (Dr Parker). 
  •  *Address correspondence to Eric M. Neverman, DO, MHA, 101 East J Avenue, Suite 120, Grundy Center, IA 50638-2006. E-mail: eric.neverman@unitypoint.org
     
Article Information
Gastroenterology / Imaging / Clinical Images
Clinical Images   |   October 2016
Porphyria Cutanea Tarda
The Journal of the American Osteopathic Association, October 2016, Vol. 116, 688. doi:10.7556/jaoa.2016.138
The Journal of the American Osteopathic Association, October 2016, Vol. 116, 688. doi:10.7556/jaoa.2016.138

Keywords: porphyria cutanea tarda, hydroxychloroquine, dermatology

A 39-year-old woman presented to the clinic with recurring blistering lesions on the dorsum of both hands. Over the course of 6 months, the patient’s skin became fragile and bumps that arose during everyday activities resolved to form pigmented scars (image). She took no regular medications and consumed alcohol socially. Results of a complete blood cell count and comprehensive metabolic panel were normal, except for mild elevation of alanine aminotransferase and aspartate aminotransferase. Additional laboratory test results revealed elevated urine uroporphyrin and heptacarboxyl porphyrin levels, which led to the diagnosis of porphyria cutanea tarda. The patient was prescribed low-dose hydroxychloroquine and the lesions resolved. She continues to have regular follow-up appointments. 
Porphyria cutanea tarda is caused by an inherited or acquired deficiency of uroporphyrin decarboxylase and may be a harbinger of underlying disease. Predisposing factors include exposure to estrogen and alcohol, as well as underlying hepatitis C virus infection, hemochromatosis,1 or diabetes mellitus.2 Accordingly, physicians must maintain a high index of suspicion for comorbidities. Treatment options include removal of offending agents, repeated phlebotomy, and chloroquine administration.3 
References
Sarkany RP. The management of porphyria cutanea tarda. Clin Exp Dermatol. 2001;26(3):225-232. [CrossRef] [PubMed]
Mũnoz-Santos C, Guilabert A, Moreno N, et al. The association between porphyria cutanea tarda and diabetes mellitus: analysis of a long-term follow-up cohort. Br J Dermatol. 2011;165(3):486-491. doi:10.1111/j.1365-2133.2011.10401.x. [CrossRef] [PubMed]
Balwani M, Desnick RJ. The porphyrias: advances in diagnosis and treatment. Blood. 2012;120(23):4496-4504. doi:10.1182/blood-2012-05-423186. [CrossRef] [PubMed]