Porphyria-like cutaneous changes induced by tetracycline hydrochloride photosensitization

Abstract

Five patients manifested cutaneous changes indistinguishable from those noted in some porphyric disorders, consisting of fragility, denudation, and blister formation of sun-exposed skin. Microscopical examination showed subepidermal bulla formation and the desposition of PAS-positive, diastase-resistant material and IgG in or around the upper dermal blood vessel walls. There was also electron microscopical evidence of vascular basal lamina reduplication and the deposition of a fine fibrillar material in and around these vessels. However, no abnormal porphyrin formation was noted. All five patients had been receiving 250 mg of tetracycline hydrochloride twice a day for at least six months and had had extensive sun exposure prior to the onset of the condition. For four patients, discontinuing the medication led to complete remission, despite subsequent sun exposure; the fifth patient was much improved, but her skin was still somewhat fragile seven months later. We concluded that these cutaneous changes resulted from a low-grade photosensitization by tetracycline hydrochloride.

Pseudoporphyria induced by voriconazole

“…Periodic acideSchiffepositive thickening of blood vessel walls and sclerosis of collagen may be noted. 1,4,5,11,12,33 DIF findings are similar to those in PCT, with granular deposits of IgG and C3 at the dermoepidermal junction and in the papillary dermal vasculature. [3][4][5][6][7]11,[15][16][17][18]33,36 Positive DIF is suggestive, but not required, for the diagnosis of pseudoporphyria.…”

“…1 A direct role is also suggested by the many reports of this disorder occurring after exposure to sunbeds, 3-9 PUVA, 10 and natural sunlight. 6,33 However, the exact UV spectrum of action is not known. One patient reported to have naproxen-induced pseudoporphyria exhibited increased sensitivity to UVA.…”

β-Lactam antibiotic-induced pseudoporphyria

“…4,5 Our patient developed pseudoporphyria while on the b-lactam antibiotics ampicillin-sulbactam and cefepime. Initial pruritus and eosinophilia developed while on ampicillin-sulbactam, which led to cessation of the drug and substitution with cefepime.…”

Systemic Antibiotics for Acne

“…Anaphylactoid or anaphylactic reactions have been reported following the use of tetracycline or minocycline [43]. Phototoxicity reactions (erythema, edema or porphyria-like cutaneous changes characterized by blistering and fragility of sun-exposed skin areas) can be caused by tetracycline [44], doxycycline [45, 46, 47] or rarely minocycline [48, 49]; they are dose related [50]. Photoonycholysis with all tetracyclines is possible and appears particularly on the occasion of mountain climbing in summer [Baran R., pers.…”