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Naproxen-induced pseudoporphyria presenting a diagnostic dilemma
E D Shelley1, W B Shelley, V Burmeister
1Department of Medicine, Medical College of Ohio, Toledo.
Cutis
|October 1, 1987
Summary
Porphyria cutanea tarda diagnosis was challenging due to negative tests. Drug-induced porphyria was confirmed when symptoms resolved after stopping naproxen and reappeared upon re-challenge.
Area of Science:
- Dermatology
- Toxicology
- Clinical Medicine
Background:
- Porphyria cutanea tarda (PCT) is the most common porphyria, characterized by photosensitivity and skin fragility.
- Diagnostic challenges arise when standard screening tests for porphyrinuria and skin biopsy findings are inconclusive.
Observation:
- A patient presented with clinical signs suggestive of PCT, but initial laboratory and histological evaluations were negative.
- The patient's skin eruption resolved after discontinuing naproxen, a nonsteroidal anti-inflammatory drug (NSAID).
Findings:
- Naproxen elimination led to symptom resolution, indicating a potential drug-induced etiology.
- A subsequent naproxen challenge test reproduced the blistering skin lesions, confirming naproxen as the causative agent.
Implications:
- This case highlights the importance of considering drug-induced porphyria, particularly when standard diagnostic methods for PCT are negative.
- NSAIDs like naproxen can unmask or induce porphyric-like skin reactions, necessitating careful medication review in patients with unexplained blistering disorders.