Porphyria Cutanea Tarda Associated with Hepatitis C
A 65-year-old man presented to the dermatology clinic with a 6-month history of worsening lesions on his hands and forearms as well as fingernail thickening. His medical history included end-stage renal disease and untreated hepatitis C virus infection. Physical examination showed crusted erosions and atrophic scars on the dorsal hands and forearms as well as scattered tense vesicles on the fingers and forearms. Onychodystrophy and subungual hyperkeratosis were observed in the fingernails. A 24-hour urine sample showed an elevated level of uroporphyrins (558 μg [672 nmol]; normal range, 0 to 24 μg [0 to 28 nmol]). A diagnosis of porphyria cutanea tarda was made. Porphyria cutanea tarda is due to acquired or inherited uroporphyrinogen decarboxylase deficiency. Risk factors for acquired disease include alcohol use, hepatitis C or human immunodeficiency virus infection, smoking, and certain medications. Treatment for hepatitis C virus infection with sofosbuvir–velpatasvir was initiated, and the patient was advised to avoid exposure to the sun. At follow-up 4 months after presentation, the patient’s skin lesions and fingernail changes had abated. He had only minimal residual blistering on his forearms.