Porphyria cutanea tarda and bullous dermatoses associated with chronic renal failure: a review1
In porphyria cutanea tarda, clinical expression may require the concordance of an inherited deficiency of the hepatic or erythrocyte enzyme uroporphyrinogen decarboxylase and an environmental precipitant, usually alcohol, iron, or estrogens. Recently, PCT and similar vesiculobullous disorders have been reported with increasing frequency in patients with impaired renal function. Many were on hemodialysis and others had ingested the photosensitizing drugs nalidixic acid and furosemide. Aluminum hydroxide and plasticizers from the dialysis tubing have also been implicated. Since abnormalities of porphyrin biochemistry were not found in all cases, more detailed porphyrin studies will be required. Plasma exchange was successful in treating one recent case of PCT in a patient on hemodialysis.