What are the signs and symptoms of porphyria cutanea tarda (PCT) in chronic hepatitis C (CHC)?

Updated: Apr 02, 2020
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Answer

PCT develops in patients who have 1 or more of the risk factors for PCT; the risk factors include exposure to chemical or toxic agents or drugs, iron overload, or excessive alcohol intake. [65, 66, 67] PCT is manifested by blisters, vesicles, and milia on the acral dorsal surfaces of the extremities, especially the tops of the hands.

Hypertrichosis of the temples, pigmentary changes, scarring, sclerodermatous changes, chloracne, ulcerations, and dystrophic calcifications are commonly the result of skin fragility with symptoms of epidermolysis bullosa.

Uroporphyrins and hepatocarboxyl porphyrins collect in the skin, bones, and teeth after they spill into the blood once the liver is saturated. These pigments, found in the plasma, fluoresce and turn the urine dark red from renal excretion. Mild elevations in the levels of these substances and in urinary aminolevulinic acid (ALA) also occur, but porphobilinogen (PPG) levels are in the reference range.

Variegate porphyria and hereditary coproporphyria have the same clinical presentation, but PPG levels are elevated in these conditions. The prevalence of PCT is related to the relative prevalence of HCV and major hemochromatosis and other iron overload genetic abnormalities.


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