Pseudoporyphyria Associated with Lemon Water and Naproxen

Background: Pseudoporyphyria is an uncommon bullous dermatosis. It shares clinical and histological features with porphyria cutanea tarda, but it occurs in the absence of porphyrin metabolic dysfunction. It is characterized by skin fragility, bullae, milia, and scarring on the dorsum of the hands and other sun-exposed areas. Case: We present a patient on naproxen with recurrent pseudoporyphyria of the dorsal hands associated with the consumption of lemon water. Findings: Biopsy showed a pauci-inflammatory sub epidermal vesicle with caterpillar bodies and laboratory studies lacked any urine or serum porphyrin abnormalities. The cutaneous lesions were noted to resolve with discontinuation of the consumption of lemon water. Keywords: Pseudoporyphyria; Porphyrin; Porphyria Cutanea Tarda; Chlorophyll; Vesicle and Depigmented