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Pseudoporphyria induced by propionic acid derivatives
S Al-Khenaizan1, J F Schechter, D Sasseville
1Division of Dermatology, Department of Medicine, Royal Victoria Hospital, Montréal, Quebec, Canada.
Journal of Cutaneous Medicine and Surgery
|May 1, 1999
Summary
Drug-induced pseudoporphyria, a photosensitive skin condition, is often caused by nonsteroidal anti-inflammatory drugs (NSAIDs). Naproxen and other propionic acid derivatives are common culprits, presenting with bullae and skin fragility despite normal porphyrin levels.
Area of Science:
- Dermatology
- Toxicology
- Pharmacology
Background:
- Pseudoporphyria is a photosensitive bullous disease distinct from porphyria cutanea tarda (PCT) by normal porphyrin levels.
- Drug-induced cases are increasing, with nonsteroidal anti-inflammatory agents (NSAIDs) being primary offenders.
Observation:
- Two cases of pseudoporphyria are presented, one linked to naproxen and the other to oxaprozin.
- Both patients exhibited tense bullae and cutaneous fragility, with characteristic skin biopsy findings.
Findings:
- Skin biopsies revealed subepidermal vesicles and festooning of dermal papillae.
- Direct immunofluorescence showed dermal-epidermal junction and perivascular staining.
- Serum and urine porphyrin levels were normal, confirming pseudoporphyria.
Implications:
- This study highlights NSAIDs, particularly naproxen and propionic acid derivatives, as significant causes of drug-induced pseudoporphyria.
- Increased awareness of pseudoporphyria's etiology and clinical presentation is crucial for timely diagnosis and management.
- Understanding the pathophysiology aids in differentiating pseudoporphyria from other porphyrias and guiding treatment strategies.