Some patients with chronic renal failure who are undergoing hemodialysis may develop a bullous disorder resembling porphyria cutanea tarda. One theory is that some porphyrins accumulate because they are too large to pass through the hemodialysis membrane.


Clinical features:

(1) hemodialysis for chronic renal failure

(2) bullous lesions on sun-exposed skin, especially the back of the hands and fingers

(3) healing of the bullae with scarring

(4) increased skin fragility

(5) normal serum, stool and urine levels of porphyrins


Biopsy of a bulla shows:

(1) subepidermal separation

(2) hypogranular mast cells

(3) thickened venule walls

(4) immunoglobulin deposits outside of the venules


Differential diagnosis:

(1) porphyria cutanea tarda

(2) porphyria

(3) drug-induced bullous disease (furosemide, tetracycline, etc)

(4) allergic reaction


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