Snapshot PCT A 50-year-old man complains of open, non-healing blisters on the dorsal surfaces of his hands. He has a history of untreated chronic hepatitis C infection. While he tries not to drink, he admits to having one glass of wine over the holidays. He denies any abdominal pain. Introduction Blistering cutaneous photosensitivity caused by hepatotoxic triggers Autosomal dominant or sporadic defect in heme synthesis login to view 2 more bullets Recurrent flares triggered by hepatotoxins that upregulate heme/P450 synthesis login to view 4 more bullets Epidemiology login to view 3 more bullets Presentation Skin findings login to view 4 more bullets Non-skin findings login to view 2 more bullets Evaluation Diagnosis by urine studies login to view 1 more bullet Differential Diagnosis Pseudoporphyria (from NSAIDs) Porphyria variegata Acute intermittent porphyria Erythropoietic protoporphyria login to view 4 more bullets Treatment Avoid exposures (alcohol, estrogen, other hepatotoxins) Sunscreen use Iron removal by phlebotomy Chloroquine Prognosis, Prevention, and Complications Prognosis login to view 1 more bullet Prevention login to view 1 more bullet