Lupus Erythematosus and Porphyria Cutanea Tarda

Porphyria cutanea tarda (PCT) can occur in patients with all subtypes of the spectrum of LE (Moshella 1989). This association has been reported in patients with DLE (Wheatherhead and Adam 1985), SLE, and SCLE (Callen and Ross 1981, Cram et al. 1973). This fact is well known, and the first cases with this association appeared in the early 1960s. Unfortunately, not all of the cases have been investigated using modern immunologic studies, and these cases cannot be specified well. The study by Wolfram in 1952 (Wolfram 1952) is the first with this association. Patients with SLE dominate the reported cases. LE occurred first in most cases. In the series by Gibson and McEvoy (Gibson and McEvoy 1998), PCT occurred either before or simultaneous with LE in almost 50% of the patients. In this article, a patient with DLE was described and 15 patients with coexistent LE and PCT were reviewed. These 15 patients were found in a group of 6,179 patients with LE - all variants - and 676 cases with PCT. Nine patients had DLE, five had SLE, and one had SCLE. The initial diagnosis was LE in eight patients, PCT in five patients, and simultaneous LE and PCT in two patients.

Often, antimalarial therapy precipitates PCT. Alcohol and sometimes estrogens and iron were also contributing factors (Callen and Ross 1981). The pathogenic pathways of the coexistence of PCT and LE remain unclear. The possible mechanisms are a common genetic fault, an acquired metabolic fault resulting in porphyria with preexisting LE, porphyria causing an autoimmune response, and a genetically determined metabolic fault for porphyria that is precipitated as a consequence of LE (Cram et al. 1973, Gibson et al. 1991). The hypothesis that lupoid hepatitis is a causative factor in patients with preceding LE is not convincing. The coexistence of both diseases is of great clinical importance. A possible complication, postulated by Callen and Ross (1981), is the treatment of PCT by phlebotomy or with antimalarial agents: Since anemia may be present in some patients with LE, phlebotomy may be unwise; moreover, phlebotomy can be an exacerbating factor for some patients with combined disorders. Anti-malarial agents used for the treatment of LE are usually used in much higher doses,and this therapy must be applied cautiously so that an acute toxic reaction does not occur. Estrogen-containing medicines and oral contraceptives should be avoided or applied with caution in both diseases. The appropriate choice of a sunscreen in patients with both diseases is also difficult. A total block must be used in patients with PCT because PCT is activated by a longer wavelength than LE.

How To Deal With Rosacea and Eczema

How To Deal With Rosacea and Eczema

Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.

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