Case 2
A 66-year-old man consulted our dermatology clinic with a chief complaint of itchy blisters on his face and forearms for 6 months. He was previously diagnosed with chronic actinic dermatitis but merely improved by avoiding sun exposure and administration of antihistamines. His medical and family history was not significant. The patient had a daily intake of 100-200ml of brandy (AVB 35-60%) for over 8 years. Physical examination revealed slight ulcers and hyperpigmentation over his face and the dorsal surface of his hands (Figure 2A-B). Laboratory findings showed mildly elevated liver enzymes: AST 111 U/L, ALT 79 U/L, GGT 163 U/L, transferrin saturation 75%. Hepatitis screen tests were negative. Urine porphyrin is positive under the Wood’s lamp (Figure 2C). Skin biopsy showed changes of superficial ulcers and crusts, epidermal spongiosis with inflammatory cell infiltrate in dermis. PAS staining showed amorphous hyaline material around the walls of capillaries. Therefore, he was diagnosed as PCT and commenced on oral glycyrrhizin and hydroxychloroquine (HCQ, 200 mg per week). We instructed him to stop drinking and avoid sun exposure. His skin lesions were significantly improved and serum levels of liver enzymes returned to normal. The patient was followed up for 2 years and maintained a satisfactory remission.