Case 1
A 63-year-old man presented recurrent blisters on his face, neck, hands
and forearms for 3 month. He was previously diagnosed as pemphigoid but
responded poorly to topical steroids. Associated symptoms included
pruritus and increased skin fragility. He denied a personal or family
history of liver disease, hepatitis and iron abnormalities. The patient
had consumed alcohol for more than 10 years with a daily amount of
150-300 ml (alcohol by volume, ABV >40%) .
Physical examination revealed multiple tense blisters, superficial
erosions with crusting and scars distributed on the face, neck,
forearms, dorsum of the hands and feet (Figure 1A-C). His laboratory
results were as follows: aspartate aminotransferase (AST) 30 U/L
(0–50), alanine aminotransferase 55 U/L (0–50) , gamma-glutamyl
transferase (GGT) 147 U/L (0–55),
transferrin saturation (TS) 65%.
Tests of hepatitis C, hepatitis B and HIV tests were negative. Wood’s
lamp examination of his urine demonstrated coral-colored fluorescence
(Figure 1D). Skin biopsy found a superficial ulcer, dilated capillaries
of the dermal papillae, perivascular extravasation of red blood cells,
infiltration of mixed inflammatory cells in the dermis and a negative
immunofluorescence staining (Figure 1E). Periodic Acid-Schiff (PAS)
staining showed deposition of purple-red material around the dermal
vessel and the dermal-epidermal junction (Figure 1F).
The patient was diagnosed with PCT and treated with glycyrrhizin during
hospitalization, and his skin lesions were greatly regressed. He was
counseled on cessation of alcohol consumption and manipulation of
photoprotection. No medication was prescribed after discharge from
hospital. The patient was followed-up for 4 years and maintained
complete remission.