September 2021 - Case of the Month
A 24-year-old woman presented with a several year history of evolving 'lumps' especially on the central chest. The lady had mild facial acne and was otherwise well.
A 57 year old man was referred with an 18 month history of a blistering eruption on the backs of both hands. There were no obvious triggers for the blisters. There was personal or family history of skin problems. The patient had arthritis for which he took naproxen. He worked as a car mechanic, drank 12 units of alcohol a week, and had no relevant hobbies.
The patient had multiple erosions where the most recent blisters had been. There were no skin changes elsewhere.
What is the diagnosis?
The diagnosis is pseudoporphyria.
Pseudoporphyria is a condition in which porphyria-like blistering of exposed skin on the extremities occurs in the absence of abnormal porphyrin metabolism. It can be caused by a number of drugs including naproxen (the case in this patient), furosemide, and nalidix acid. Once the drug is stopped the blisters will settle although this can take some time.
True porphyrias result from altered metabolism in the haem biosynthesis pathway, leading to an accumulation of porphyrins. There are three main types - porphyria cutanea tarda (PCT), variegate porphyria and erythrohepatic protoporphyria.
PCT is the most common type of porphryia, blisters result from a reaction between the porphyrins in the skin and UV radiation, which goes on to cause cell damage. Features of PCT include:
Please follow the link to read more about porphyria.
A 24-year-old woman presented with a several year history of evolving 'lumps' especially on the central chest. The lady had mild facial acne and was otherwise well.
A 52 year old man presented with a one year history of skin lesions predominantly on his hands, ears and scalp. He was also complaining of painful swollen fingers associated with morning stiffness. There was no family history of skin or joint problem...
A 72 year old man was referred with a rash, predominantly on the legs. The patient was systemically well and the lesions were only mildly symptomatic. The lesions presented as one to several at a time lasting several weeks. They had not res...
Welcome back to the new look PCDS website, and our first case. This lady was referred as a 2-week wait with a changing lesion on the right temple.
A 15 year old lady was referred for a diagnostic opinion for skin changes presenting in birth, affecting the right upper back, shoulder, antecubital fossa and dorsal wrist. The patient was asymptomatic and otherwise well.
The following pharmaceutical companies have had no involvement in the content of this website or in our conference programmes
