Farman_BaniMarani

Internal Medicine Resident

Long time skin lesion

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Author: Dr. Shamas Rafique MD, Co-author: Dr. Iqra Rafiq MD
Case Study: Porphyria Cutanea Tarda in a 70-Year-Old Asian Patient with Hepatitis C History

Introduction:

This case study presents a 70-year-old Asian patient with a history of treated Hepatitis C who exhibited itching, fragile skin, rashes, skin pigmentation changes, and unresolved sunburns. Laboratory tests confirmed Porphyria cutanea tarda (PCT), a rare disorder caused by impaired heme synthesis leading to porphyrin accumulation in the skin. Due to cost constraints, the patient underwent 24-hour urine tests for porphobilinogen and delta-aminolevulinic acid (ALA) only.

Case Presentation:

The patient, a 70-year-old Asian male, presented with pruritus, skin fragility, rashes, and cutaneous pigmentation changes, primarily in sun-exposed areas. Denying any skin-related issues, the patient had a past history of successfully treated Hepatitis C.

Diagnostic Assessment:

Limited laboratory tests were conducted due to financial constraints. The 24-hour urine porphobilinogen level measured 10.6, indicating impaired heme synthesis, while urine ALA level showed ALA/24 h at 17.8, confirming the diagnosis of Porphyria cutanea tarda.

Treatment and Outcome:

With a confirmed diagnosis, the patient received a prescription for hydroxychloroquine 125mg P.O. twice a week. The treatment was beneficial, with the patient experiencing reduced pruritus, improved skin fragility, and a positive response in terms of skin pigmentation changes and sunburn resolution.

Discussion:

Porphyria cutanea tarda often accompanies hepatic diseases, as demonstrated by the patient's history of treated Hepatitis C. The case highlights the importance of considering porphyria as a differential diagnosis in patients with relevant medical histories and skin manifestations. Hydroxychloroquine has shown efficacy in managing PCT symptoms by reducing porphyrin accumulation in the skin. Further monitoring and follow-up are required to assess long-term treatment efficacy and safety.

Conclusion:

This case study emphasizes the successful diagnosis and management of Porphyria cutanea tarda in a 70-year-old Asian patient with a history of treated Hepatitis C. Early recognition and hydroxychloroquine therapy led to significant symptom improvement. Regular follow-up is essential to evaluate treatment effectiveness and safety.

Hi everyone.
Do you have any experience in PDT in treatment of FD?
This patient has gone through rifampicin+clindamycin, isotretinoin several times and ADA for 18 months with no improvement.
I have Triwings LED and I thought about several PDT courses with INN: 5-aminolevulinic acid.
Have you done such procedures? Any tips? Isn’t the affected area too large for this kind of treatment? Or maybe surgical procedure would be better?

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