Medscape is available in 5 Language Editions – Choose your Edition here.


Pseudoporphyria Clinical Presentation

  • Author: Vineet Mishra, MD, FAAD; Chief Editor: Dirk M Elston, MD  more...
Updated: Jun 21, 2016


A careful history is of utmost importance when the diagnosis of pseudoporphyria is being considered. A personal and family history of hepatitis, porphyria, or photosensitivity disorder must be sought.

Although a genetic factor has not been considered in pseudoporphyria, one case of monozygotic twins developing pseudoporphyria after excessive UV-A exposure from long-term tanning bed use has been documented.[5]

The patient should be thoroughly questioned regarding any symptoms of connective tissue disorder, which may be the underlying pathology of the photosensitivity. Some reports suggest that a connective-tissue disorder may be a predisposing factor in patients using nonsteroidal anti-inflammatory drugs (NSAIDs) who develop pseudoporphyria.



Pseudoporphyria is clinically characterized by increased skin fragility; erythema; and the appearance of tense bullae and erosions on sun-exposed skin, which are identical to those seen in patients with porphyria cutanea tarda. However, a clinical pearl that may prove helpful in differentiating between pseudoporphyria and porphyria cutanea tarda is that the classic features of hypertrichosis, hyperpigmentation, and sclerodermoid changes found with porphyria cutanea tarda are unusual with pseudoporphyria. Additionally, those patients who develop pseudoporphyria in association with the use of tanning beds may develop lesions on the palmar surfaces, which are usually not subject to UV exposure.[13]

A second clinical pattern of pseudoporphyria has a similar presentation to erythropoietic protoporphyria (EPP), an autosomal dominant porphyria resulting from a reduced activity of ferrochelatase. In contrast to porphyria cutanea tarda, erythropoietic protoporphyria usually begins in childhood with a history of photosensitivity, often described as a burning sensation immediately after sunlight exposure. Clinically, erythropoietic protoporphyria is characterized by erythema, edema, shallow scars, and waxy induration of the skin, particularly on the face. Pseudoporphyria that clinically mimics erythropoietic protoporphyria has been described almost exclusively in children taking naproxen for juvenile rheumatoid arthritis.[14] Naproxen-induced pseudoporphyria seems to have a dimorphic presentation with the porphyria cutanea tarda–like pattern more often seen in the adult population and the erythropoietic protoporphyria–like pattern more commonly seen in children, although some overlap has been documented.



Pseudoporphyria can be induced by a wide range of medications, excessive UV-A exposure, and hemodialysis.[15, 16, 17] Onset of bullae may occur weeks to months after a drug has been initiated.[18]

pseudoporphyria will most likely continue to grow. Agents associated with pseudoporphyria are as follows[19, 20] :

  • Propionic acid derivatives (NSAIDs) [21, 22] - Naproxen, [19, 23, 24, 25, 26, 27, 28] diflunisal, ketoprofen, nabumetone, [29, 30] oxaprozin, [31] mefenamic acid, [32] rofecoxib [33]
  • Antibiotics - Nalidixic acid, [34, 35] tetracycline, [36] oxytetracycline, [37] ampicillin-sulbactam, cefepime, [38] ciprofloxacin [39]
  • Antifungals - Voriconazole [40, 41]
  • Diuretics - Furosemide, [42] chlorthalidone, [43] butamide, triamterene/hydrochlorothiazide, torsemide, [44] bumetanide [45]
  • Antiarrhythmics - Amiodarone [46]
  • Chemotherapy - 5-Fluorouracil, [47] imatinib [48]
  • Immunosuppressants - Cyclosporine [49]
  • Sulfones - Dapsone
  • Vitamins - Brewers' yeast, [27] pyridoxine [50]
  • Vitamin A derivatives - Etretinate, [51] isotretinoin [52]
  • Muscle relaxants - Carisoprodol, aspirin [53]
  • Nonsteroidal antiandrogens - Flutamide [54]
  • Other - Hemodialysis, [55, 56] excessive UV-A, cola, [57] oral contraceptive pills (levonorgestrel and ethinyl estradiol), [58] narrowband UV-B [59] phototherapy (rarely), and possibly country mallow, an herb regional to India [60]

Vitiligo may be associated with pseudoporphyria.[61, 62] Several reports describe patients with vesicles, bullae, and scarring confined to areas of vitiligo on the dorsa of the hands with sparing of normally pigmented skin while taking medications known to cause pseudoporphyria. It is well established that the clinical findings of pseudoporphyria may be precipitated or exacerbated by sunlight. One author suggests that the presence of melanin in healthy skin may be adequate protection to prevent the development of pseudoporphyria in patients with vitiligo.

Contributor Information and Disclosures

Vineet Mishra, MD, FAAD Director of Mohs Surgery and Dermatologic Surgery, Assistant Professor of Dermatology, University of Texas Health Science Center at San Antonio

Vineet Mishra, MD, FAAD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, American College of Phlebology, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery

Disclosure: Nothing to disclose.


Garrett Lane Vick, MD Intern Physician, Department of Internal Medicine, University of Texas Health Science Center at San Antonio School of Medicine

Garrett Lane Vick, MD is a member of the following medical societies: American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD Associate Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Maureen B Poh-Fitzpatrick, MD Professor Emerita of Dermatology and Special Lecturer, Columbia University College of Physicians and Surgeons

Maureen B Poh-Fitzpatrick, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, New York Dermatological Society

Disclosure: Nothing to disclose.

Elizabeth L Tanzi, MD Co-Director, Laser Surgery, Washington Institute of Dermatologic Laser Surgery; Assistant Professor, Department of Dermatology, George Washington University School of Medicine

Elizabeth L Tanzi, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, American Medical Association

Disclosure: Nothing to disclose.

Vincent A De Leo, MD Clinical Professor of Dermatology, Department of Dermatology, College of Physicians and Surgeons of Columbia University; Chairman, Department of Dermatology, Director of Dermatology Residency Training Program, St Luke's-Roosevelt Hospital Center; Chairman, Department of Dermatology, Beth Israel Medical Center

Vincent A De Leo, MD is a member of the following medical societies: American Academy of Dermatology, New York County Medical Society, American Society for Photobiology, Photomedicine Society, American College of Occupational and Environmental Medicine, Women's Dermatologic Society, American Contact Dermatitis Society, Dermatology Foundation, American Medical Association, New York Academy of Medicine, Society for Investigative Dermatology, Society of Toxicology

Disclosure: Received consulting fee from estee lauder for consulting; Received consulting fee from laroche posay for consulting; Received consulting fee from schering plough for consulting; Received consulting fee from pfizer for consulting; Received grant/research funds from orfagen for study - clinical.

  1. Waldenström J. Studein uber porphyrie. Acta Med Scand. 1937. 82:1.

  2. Zelickson AS. Phototoxic reaction with nalidixic acid. JAMA. 1964 Nov 9. 190:556-7. [Medline].

  3. Burry JN, Lawrence JR. Phototoxic blisters from high frusemide dosage. Br J Dermatol. 1976 May. 94(5):495-9. [Medline].

  4. Stenberg A. Pseudoporphyria and sunbeds. Acta Derm Venereol. 1990. 70(4):354-6. [Medline].

  5. Wilson CL, Mendelsohn SS. Pseudoporphyria and sunbeds, a coincidence in identical twins?. Br J Dermatol. 1991 Aug. 125(2):191. [Medline].

  6. Quaiser S, Khan R, Khan AS. Drug induced pseudoporphyria in CKD: A case report. Indian J Nephrol. 2015 Sep-Oct. 25 (5):307-9. [Medline].

  7. Keane JT, Pearson RW, Malkinson FD. Nalidixic acid-induced photosensitivity in mice: a model for pseudoporphyria. J Invest Dermatol. 1984 Mar. 82(3):210-3. [Medline].

  8. Dabski C, Beutner EH. Studies of laminin and type IV collagen in blisters of porphyria cutanea tarda and drug-induced pseudoporphyria. J Am Acad Dermatol. 1991 Jul. 25(1 Pt 1):28-32. [Medline].

  9. Wallace CA, Farrow D, Sherry DD. Increased risk of facial scars in children taking nonsteroidal antiinflammatory drugs. J Pediatr. 1994 Nov. 125(5 Pt 1):819-22. [Medline].

  10. Schanbacher CF, Vanness ER, Daoud MS, Tefferi A, Su WP. Pseudoporphyria: a clinical and biochemical study of 20 patients. Mayo Clin Proc. 2001 May. 76 (5):488-92. [Medline].

  11. Brinster NK, Liu V, Diwan AH, McKee PH, eds. Pseudoporphyria. Dermatopathology: High-Yield Pathology. Elsevier; 2011.

  12. Mehta S, Lang B. Long-term followup of naproxen-induced pseudoporphyria in juvenile rheumatoid arthritis. Arthritis Rheum. 1999 Oct. 42 (10):2252-4. [Medline].

  13. Poblete-Gutiérrez FJ, Weitz JI. Porphyria. Bolognia JL, Jorizzo JL, Schaffer JV, et al, eds. Dermatology. 3rd ed. Elsevier; 2012. Chapter 49.

  14. Lang BA, Finlayson LA. Naproxen-induced pseudoporphyria in patients with juvenile rheumatoid arthritis. J Pediatr. 1994 Apr. 124(4):639-42. [Medline].

  15. Markova A, Lester J, Wang J, Robinson-Bostom L. Diagnosis of common dermopathies in dialysis patients: a review and update. Semin Dial. 2012 Jul. 25(4):408-18. [Medline].

  16. Onelmis H, Sener S, Sasmaz S, Ozer A. Cutaneous changes in patients with chronic renal failure on hemodialysis. Cutan Ocul Toxicol. 2012 Dec. 31(4):286-91. [Medline].

  17. Pranteda G, Bottoni U, Tayefeh Jafari M, Pranteda G, De Micco S, Muscianese M, et al. Dialysis-associated pseudoporphyria successfully treated with vitamin D. Report of two cases. G Ital Dermatol Venereol. 2015 Jun. 150 (3):327-9. [Medline].

  18. Habif TP, ed. Light-related diseases and disorders of pigmentation. Clinical Dermatology. 6th ed. Elsevier; 2016. Chapter 19.

  19. Suarez SM, Cohen PR, DeLeo VA. Bullous photosensitivity to naproxen: "pseudoporphyria". Arthritis Rheum. 1990 Jun. 33(6):903-8. [Medline].

  20. Beer K, Applebaum D, Nousari C. PseudoPorphyria: discussion of etiologic agents. J Drugs Dermatol. 2014 Aug. 13 (8):990-2. [Medline].

  21. Al-Khenaizan S, Schechter JF, Sasseville D. Pseudoporphyria induced by propionic acid derivatives. J Cutan Med Surg. 1999 Jan. 3(3):162-6. [Medline].

  22. Taylor BJ, Duffill MB. Pseudoporphyria from nonsteroidal antiinflammatory drugs. N Z Med J. 1987 May 27. 100(824):322-3. [Medline].

  23. Allen R, Rogers M, Humphrey I. Naproxen induced pseudoporphyria in juvenile chronic arthritis. J Rheumatol. 1991 Jun. 18(6):893-6. [Medline].

  24. Girschick HJ, Hamm H, Ganser G, Huppertz HI. Naproxen-induced pseudoporphyria: appearance of new skin lesions after discontinuation of treatment. Scand J Rheumatol. 1995. 24(2):108-11. [Medline].

  25. Howard AM, Dowling J, Varigos G. Pseudoporphyria due to naproxen. Lancet. 1985 Apr 6. 1(8432):819-20. [Medline].

  26. Judd LE, Henderson DW, Hill DC. Naproxen-induced pseudoporphyria. A clinical and ultrastructural study. Arch Dermatol. 1986 Apr. 122(4):451-4. [Medline].

  27. Levy ML, Barron KS, Eichenfield A, Honig PJ. Naproxen-induced pseudoporphyria: a distinctive photodermatitis. J Pediatr. 1990 Oct. 117(4):660-4. [Medline].

  28. Sterling JC, Pye RJ. Naproxen-induced pseudoporphyria. Br J Rheumatol. 1987 Jun. 26(3):210-1. [Medline].

  29. Krischer J, Scolari F, Kondo-Oestreicher M, Vollenweider-Roten S, Saurat JH, Pechere M. Pseudoporphyria induced by nabumetone. J Am Acad Dermatol. 1999 Mar. 40(3):492-3. [Medline].

  30. Magro CM, Crowson AN. Pseudoporphyria associated with Relafen therapy. J Cutan Pathol. 1999 Jan. 26(1):42-7. [Medline].

  31. Ingrish G, Rietschel RL. Oxaprozin-induced pseudoporphyria. Arch Dermatol. 1996 Dec. 132(12):1519-20. [Medline].

  32. O'Hagan AH, Irvine AD, Allen GE, Walsh M. Pseudoporphyria induced by mefenamic acid. Br J Dermatol. 1998 Dec. 139(6):1131-2. [Medline].

  33. Markus R, Reddick ME, Rubenstein MC. Rofecoxib-induced pseudoporphyria. J Am Acad Dermatol. 2004 Apr. 50(4):647-8. [Medline].

  34. Bilsland D, Douglas WS. Sunbed pseudoporphyria induced by nalidixic acid. Br J Dermatol. 1990 Oct. 123(4):547. [Medline].

  35. Birkett DA, Garretts M, Stevenson CJ. Phototoxic bullous eruptions due to nalidixic acid. Br J Dermatol. 1969 May. 81(5):342-4. [Medline].

  36. Epstein JH, Seibert JS. Porphyria-like cutaneous changes induced by tetracycline hydrochloride photosensitization. Arch Dermatol. 1976 May. 112(5):661-6. [Medline].

  37. Hawk JL. Skin changes resembling hepatic cutaneous porphyria induced by oxytetracycline photosensitization. Clin Exp Dermatol. 1980 Sep. 5(3):321-5. [Medline].

  38. Phung TL, Pipkin CA, Tahan SR, Chiu DS. Beta-lactam antibiotic-induced pseudoporphyria. J Am Acad Dermatol. 2004 Aug. 51(2 Suppl):S80-2. [Medline].

  39. Degiovanni CV, Darley CR. Pseudoporphyria occurring during a course of ciprofloxacin. Clin Exp Dermatol. 2008 Jan. 33(1):109-10. [Medline].

  40. Dolan CK, Hall MA, Blazes DL, Norwood CW. Pseudoporphyria as a result of voriconazole use: a case report. Int J Dermatol. 2004 Oct. 43(10):768-71. [Medline].

  41. Kwong WT, Hsu S. Pseudoporphyria associated with voriconazole. J Drugs Dermatol. 2007 Oct. 6(10):1042-4. [Medline].

  42. Breier F, Feldmann R, Pelzl M, Gschnait F. Pseudoporphyria cutanea tarda induced by furosemide in a patient undergoing peritoneal dialysis. Dermatology. 1998. 197(3):271-3. [Medline].

  43. Baker EJ, Reed KD, Dixon SL. Chlorthalidone-induced pseudoporphyria: clinical and microscopic findings of a case. J Am Acad Dermatol. 1989 Nov. 21(5 Pt 1):1026-9. [Medline].

  44. Perez-Bustillo A, Sanchez-Sambucety P, Suarez-Amor O, Rodriiguez-Prieto MA. Torsemide-induced pseudoporphyria. Arch Dermatol. 2008 Jun. 144(6):812-3. [Medline].

  45. Leitao EA, Person JR. Bumetanide-induced pseudoporphyria. J Am Acad Dermatol. 1990 Jul. 23(1):129-30. [Medline].

  46. Parodi A, Guarrera M, Rebora A. Amiodarone-induced pseudoporphyria. Photodermatol. 1988 Jun. 5(3):146-7. [Medline].

  47. Laidman PJ, Gebauer K, Trotter J. 5-Fluorouracil-induced pseudoporphyria. Aust N Z J Med. 1992 Aug. 22(4):385. [Medline].

  48. Timmer-de Mik L, Kardaun SH, Kramer MH, Hayes DP, Bousema MT. Imatinib-induced pseudoporphyria. Clin Exp Dermatol. 2008 Dec 9. [Medline].

  49. Sola R, Puig LL, Ballarin JA, Donate T, del Rio G. Pseudoporphyria cutanea tarda associated with cyclosporine therapy. Transplantation. 1987 May. 43(5):772. [Medline].

  50. Baer RL. Cutaneous skin changes probably due to pyridoxine abuse. J Am Acad Dermatol. 1984 Mar. 10(3):527-8. [Medline].

  51. McDonagh AJ, Harrington CI. Pseudoporphyria complicating etretinate therapy. Clin Exp Dermatol. 1989 Nov. 14(6):437-8. [Medline].

  52. Riordan CA, Anstey A, Wojnarowska F. Isotretinoin-associated pseudoporphyria. Clin Exp Dermatol. 1993 Jan. 18(1):69-71. [Medline].

  53. Hazen PG. Pseudoporphyria in a patient receiving carisoprodol/aspirin therapy. J Am Acad Dermatol. 1994 Sep. 31(3 Pt 1):500. [Medline].

  54. Borroni G, Brazzelli V, Baldini F, et al. Flutamide-induced pseudoporphyria. Br J Dermatol. 1998 Apr. 138(4):711-2. [Medline].

  55. Gilchrest B, Rowe JW, Mihm MC Jr. Bullous dermatosis of hemodialysis. Ann Intern Med. 1975 Oct. 83(4):480-3. [Medline].

  56. Bergler-Czop B, Brzezińska-Wcisło L. Pseudoporphyria induced by hemodialysis. Postepy Dermatol Alergol. 2014 Feb. 31 (1):53-5. [Medline].

  57. Judd L. Pseudoporphyria due to cola. Int J Dermatol. 1991 Sep. 30(9):674-5. [Medline].

  58. Silver EA, Silver AH, Silver DS, McCalmont TH. Pseudoporphyria induced by oral contraceptive pills. Arch Dermatol. 2003 Feb. 139(2):227-8. [Medline].

  59. Oh C, Jones B, Solomon R, Egan CA. Pseudoporphyria secondary to narrowband UVB phototherapy for psoriasis. Australas J Dermatol. 2006 May. 47(2):134-6. [Medline].

  60. Garg T, Barara M, Chander R, Meena S, Agarwal S. Pseudoporphyria: A Case Report. Indian J Dermatol. 2015 May-Jun. 60 (3):324. [Medline].

  61. Burns DA. Naproxen pseudoporphyria in a patient with vitiligo. Clin Exp Dermatol. 1987 Jul. 12(4):296-7. [Medline].

  62. Motley RJ. Pseudoporphyria due to dyazide in a patient with vitiligo. BMJ. 1990 Jun 2. 300(6737):1468. [Medline].

  63. Maynard B, Peters MS. Histologic and immunofluorescence study of cutaneous porphyrias. J Cutan Pathol. 1992 Feb. 19(1):40-7. [Medline].

  64. Guiotoku MM, Pereira Fde P, Miot HA, Marques ME. Pseudoporphyria induced by dialysis treated with oral N-acetylcysteine. An Bras Dermatol. 2011 Mar-Apr. 86 (2):383-5. [Medline].

  65. Vadoud-Seyedi J, de Dobbeleer G, Simonart T. Treatment of haemodialysis-associated pseudoporphyria with N-acetylcysteine: report of two cases. Br J Dermatol. 2000 Mar. 142 (3):580-1. [Medline].

  66. James WD, Berger TG, Elston DM, eds. Errors in Metabolism. Andrews’ Diseases of the Skin. 12th ed. Elsevier; 2016. Chapter 26.

All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.