Porphyria cutanea tarda
This disorder, which can also be precipitated by sunlight, was also a possibility with our patient. It tends to present with vesicles or bullae in sun-exposed areas, especially the dorsum of the hands.2 The bullae generally have no surrounding erythema, which made it an unlikely diagnosis for our patient. A diagnosis of porphyria cutanea tarda hinges on increased porphyrin levels, measured in a 24-hour urine collection.
Steroids, antihistamines, sunblock, and long sleeves
Treatment for polymorphous light eruption includes topical steroids and antihistamines.1-3 Patients can attempt to prevent future episodes by applying broad-spectrum (UVA and UVB coverage) sunblock and wearing long-sleeved garments when going out in the sun.
Desensitization with phototherapy is often necessary. UVA, UVB, and PUVA have all proven beneficial.5
Hydroxychloroquine. Recalcitrant cases may require hydroxychloroquine during the summer months.6
Nonadherence hinders our patient’s recovery
We started our patient on oral antihistamines and topical steroids and recommended that she avoid direct sunlight.
Our patient, however, didn’t avoid sun exposure, and when we saw her on follow-up, her pruritis had improved, but the lesions were essentially unchanged.
We subsequently lost our patient to follow-up.