Describe the porphyria-like eruption of dialysis.

Patients with chronic renal failure on dialysis sometimes develop skin fragility, blisters, hyperpigmentation, and hypertrichosis that is indistinguishable from the cutaneous lesions seen in porphyria cutanea tard (PCT). Although most of these patients do not have elevated levels of porphyrins (pseudoporphyria), some do. When these patients are anuric, plasma and fecal specimens are submitted for porphyrin studies. Elevated porphyrin levels are due to decreased elimination, poor erythropoiesis, decreased activity of uroporphyrinogen decarboxylase (enzyme responsible for PCT), and failure of hemodialysis to remove porphyrins. Hepatitis C infection, iron overload, and medications are exacerbating factors.

Green JJ, Manders SM: Pseudoporphyria, J Am Acad Dermatol 44:100–108, 2001.

Poh-Fitzpatrick MB, Masullo AS, Grossman ME: Porphyria cutanea tarda associated with chronic renal disease and hemodialysis, Arch Dermatol 116:191–195, 1980.