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Pseudoporphyria Treatment & Management

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

Medical Care

The primary treatment of pseudoporphyria is to discontinue the offending agent whenever possible. This may be facilitated by substituting certain medications (eg, tolmetin instead of naproxen for juvenile rheumatoid arthritis, nonthiazide agents for hypertension) for alternative agents that have not been associated with pseudoporphyria.[6, 12] Additionally, sun protection is used as both therapy and prophylaxis against recurrent eruptions, and patients should be adequately educated on this topic.[13] Patients should avoid direct sun exposure, wear sun-protective clothing, and apply titanium oxide‒ or zinc oxide‒based sunscreens, which are resistant to wavelengths that are known to induce porphyric eruptions (400-440 nm).[13] Resolution of the clinical findings may take many months, particularly in drug-induced pseudoporphyria.

In addition to discontinuation of causative agents, N-acetylcysteine (a glutathione precursor) has been reported to improve dialysis associated pseudoporphyria.[6, 64, 65] Proponents of this therapy have proposed that patients on hemodialysis have decreased levels of glutathione,4,5 (an antioxidant) and that reactive oxygen species may contribute to skin damage.[65] One case series involving two patients with pseudoporphyria demonstrated rapid healing of lesions in both patients after the introduction of N-acetylcysteine (with one patient receiving 200 mg four times daily and the other 600 mg twice daily) to treatment, which was otherwise unchanged.[65] It was also noted that discontinuation of the medication in one patient led to a recurrence of blistering. Further investigations evaluating the efficacy are needed to confirm results. However, oral N-acetylcysteine has few, mild adverse effects consisting of nausea, vomiting, and diarrhea and has been suggested to be a safe therapeutic option for pseudoporphyria complicating hemodialysis.[65]

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.

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