Background

This is a bullous dermatosis which is also known as drug-induced porphyria or therapy induced bullous photosensitivity. There are many drugs which have been implicated, many are listed below. In addition to drugs, there have been cases associated with chronic renal failure patients undergoing hemodialysis.

Acetaminophen Alcohol Aspirin Barbiturates Bromides Bumetanide Carbamazepine Chlorthalidone Chlordiazepoxide Chlorpropamide Contraceptives, oral Cyclosporine Damazol Dapsone Diflunisal

Estrogens Ergots Etretinate Fluoroquinolones Furosemide Glucocorticoids Glutethimide Griseofulvin Hydrochlorthiazide Insulin Katoprofen Meprobamate Methyprylon Nalidixic acid Naprosyn Naproxen

Narcotic analgesics Nifedipine Penicillin and derivatives Phenothiazines Phenytoin Photofrin Progestogens Pyrazolones Pyridoxine (Vitamin B6) Rifampin Streptomycin Succinimides Sulfonamides Tetracycline Valproic acid

Harrison's Principles of Internal Medicine. 14th Edition. 1998.

Unlike cases of porphyria, there are no laboratory abnormalities. The clinical lesions resemble porphyria cutanea tarda with spontaneous blisters and skin fragility, usually on the dorsum of the hands. Lesions may develop from 1 week to several months after the start of the drugs. There usually is no hypertrichosis, hyperpigmentation, or sclerodermoid changes.

The microscopic changes are similar to that seen in porphyria cutanea tarda.

Porphyria

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