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- Presentation
Skinternal Medicine: An Update on Cutaneous Manifestations of Systemic Disease
Description
The presentation discusses a case of a 34-year-old woman with a history of anxiety, depression, and iron deficiency anemia who developed blisters on her hands after coloring her hair. The case led to evaluations revealing porphyria cutanea tarda (PCT), a condition characterized by blisters, scarring, and skin manifestations linked to iron overload and various factors such as liver dysfunction. The diagnosis was confirmed through skin biopsy, which showed typical changes associated with PCT, and elevated porphyrins in serum and urine. The presentation then explained the multifactorial nature of PCT, emphasizing that it can be sporadic or familial and is often exacerbated by iron overload. The management for the condition highlights the importance of sun protection and treatment methods such as phlebotomy and antimalarials. In this case, phlebotomy was used due to the patient's inability to take antimalarials due to medication interactions. The discussion wrapped up by reinforcing the significance of a thorough evaluation, including monitoring iron levels and porphyrin levels, and the role of avoiding triggers, leading to successful healing of the patient's condition.
View moreConclusions
- Porphyria cutanea tarda (PCT) is the most common type of porphyria, often triggered by iron overload.
- PCT is characterized by the formation of noninflammatory bullae on sun-exposed areas, especially the dorsal hands.
- Diagnosis of PCT can be confirmed through elevated serum and urine porphyrins as well as skin biopsy showing festooning of the dermal papillae.
- Conditions predisposing to PCT include alcohol use, hepatitis C infection, and iron overload from frequent transfusions or supplements.
- First-line treatment for PCT involves strict sun protection and may include phlebotomy or antimalarial medications like hydroxychloroquine.
- Phlebotomy sessions are typically required until ferritin levels fall to a target range, and this process can take multiple sessions.
- Ongoing evaluation for liver function and potential complications is essential for patients diagnosed with PCT.
- Pseudoporphyria can mimic PCT but is characterized by normal porphyrin levels and may be triggered by certain medications.
- Andrews 12e
- Habif 6e
- Bolognia 4e
- From Anderson KE: Hepatology 45(1):6-8, 2007 PMID: 17187403; and Rossmann-Ringdahl I, Olsson R: Acta Dermatol Venereol 85(4):337-344, 2005. PMID: 16191856
- William McKane, Christina A. Green, Ken Farrington. Porphyria cutanea tarda precipitated by intravenous iron in a haemodialysis patient. Nephrology Dialysis Transplantation, Volume 16, Issue 9, September 2001, Pages 1936-1938, https://doi.org/10.1093/ndt/16.9.1936
- PMCID: PMC8341219 Published online 2021 Jul 6. doi: 10.7759/cureus. 16215 PMCID: PMC8341219.