Chronic alcoholic with cutaneous blisters: Have a look at the urine

Porphyria cutanea tarda (PCT) encompasses a heterogeneous group of disorders that can be acquired or inherited. It is usually characterised by photosensitivity and skin fragility over sun exposed parts and red coloured urine. We hereby report a 46-year-old chronic alcoholic who presented with blisters and itchy skin lesions over the sun exposed parts since 3 months. He had history of alcohol consumption for past 20 years. Cutaneous examination revealed few vesicles, crusting, hyperpigmentation and thickening of skin over sun exposed parts. Urine appeared red on gross examination and showed coral pink fluorescence under Wood’s lamp. Biopsy taken from a vesicle revealed subepidermal blister with festooning of dermal papillae. DIF studies showed deposits of IgG at the dermo-epidermal junction and around blood vessels which were PAS positive. Based on the above findings a presumptive diagnosis of porphyria cutanea tarda was made. Any case presenting with cutaneous blisters along with history of chronic alcoholism should arouse the suspicion of Porphyria cutanea tarda. Gross examination of urine usually reveals a diagnostic clue in such cases which should be followed by a workup of porphyrin profile to rule out other acute porphyrias and other causes of photo-induced bullous dermatosis. Precipitating factors are invariably found in cases of PCT which should be thoroughly investigated as the avoidance of these factors play a major role in the management.