JEADV
LETTER TO THE EDITOR
Pseudoporphyria – a case report Editor A 69-year-old paraplegic woman with a history of antiphospholipid syndrome and vitiligo presented with tense bullae on both knees (Fig. 1). Two days previously, she had rested outdoors with flexed knees facing the sun. Porphyrin assays of red blood cells, plasma, urine and faeces were normal, as were levels of antinuclear antibodies. Histological examination (Fig. 2) showed an inflammatory infiltrate without thickening of vessel walls and a negative direct immunofluorescence. The patient’s current medications included warfarin, letrozole and tolterodine. She was diagnosed with pseudoporphyria and treated conservatively. For almost 6 months after bullae formation, the patient has suffered from prolonged wound healing at her knees. Pseudoporphyria is a common, but underdiagnosed phototoxic bullous skin reaction that can be induced by a wide range of medications, excessive exposure to UVA from sunbeds, or haemodialysis.1 In this case, tolterodine was suspected to be the offending drug.2 The primary treatment is removal of the triggering cause if possible and avoidance of intensive sunlight. It may take months for the skin lesions to resolve. Some patients heal with scarring.
Figure 2 Skin histology showing an inflammatory infiltrate with early subepidermal microvesiculation. The bulla starts in the left corner.
M. Gyldenløve,1 E. Due,1 M.F. Jonkman,2 A. Faurschou1,* 1 Department of Dermato-Allergology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark, 2Department of Dermatology, Centre for Blistering Diseases, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands *Correspondence: A. Faurschou. E-mail: [email protected]
References
1 Green JJ, Manders SM. Pseudoporphyria. J Am Acad Dermatol 2001; 44: 100–108. 2 eHealtMe. Pseudoporphyria in Detrol. [WWW document] 2013. URL http://www.ehealthme.com/ds/detrol/pseudoporphyria (last accessed: 11 December 2013). DOI: 10.1111/jdv.12433
Figure 1 The two bullae that developed on the knees of the patient following exposure to sunlight.
JEADV 2014
© 2014 European Academy of Dermatology and Venereology
LETTER TO THE EDITOR
Pseudoporphyria – a case report Editor A 69-year-old paraplegic woman with a history of antiphospholipid syndrome and vitiligo presented with tense bullae on both knees (Fig. 1). Two days previously, she had rested outdoors with flexed knees facing the sun. Porphyrin assays of red blood cells, plasma, urine and faeces were normal, as were levels of antinuclear antibodies. Histological examination (Fig. 2) showed an inflammatory infiltrate without thickening of vessel walls and a negative direct immunofluorescence. The patient’s current medications included warfarin, letrozole and tolterodine. She was diagnosed with pseudoporphyria and treated conservatively. For almost 6 months after bullae formation, the patient has suffered from prolonged wound healing at her knees. Pseudoporphyria is a common, but underdiagnosed phototoxic bullous skin reaction that can be induced by a wide range of medications, excessive exposure to UVA from sunbeds, or haemodialysis.1 In this case, tolterodine was suspected to be the offending drug.2 The primary treatment is removal of the triggering cause if possible and avoidance of intensive sunlight. It may take months for the skin lesions to resolve. Some patients heal with scarring.
Figure 2 Skin histology showing an inflammatory infiltrate with early subepidermal microvesiculation. The bulla starts in the left corner.
M. Gyldenløve,1 E. Due,1 M.F. Jonkman,2 A. Faurschou1,* 1 Department of Dermato-Allergology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark, 2Department of Dermatology, Centre for Blistering Diseases, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands *Correspondence: A. Faurschou. E-mail: [email protected]
References
1 Green JJ, Manders SM. Pseudoporphyria. J Am Acad Dermatol 2001; 44: 100–108. 2 eHealtMe. Pseudoporphyria in Detrol. [WWW document] 2013. URL http://www.ehealthme.com/ds/detrol/pseudoporphyria (last accessed: 11 December 2013). DOI: 10.1111/jdv.12433
Figure 1 The two bullae that developed on the knees of the patient following exposure to sunlight.
JEADV 2014
© 2014 European Academy of Dermatology and Venereology
