The Case Files

A 58-year-old man with end-stage renal disease (ESRD) undergoing hemodialysis presented with nail changes and painful blisters on his hands, diagnosed as pseudoporphyria, a rare blistering skin condition often linked to hemodialysis or certain medications. Despite normal serum porphyrin levels, which ruled out porphyria cutanea tarda (PCT), the patient's condition was attributed to hemodialysis, as withdrawal of simvastatin, a potential drug cause, did not improve symptoms. Pseudoporphyria in hemodialysis patients may be due to free radical damage, exacerbated by reduced antioxidant levels. Treatment involved sun avoidance, photoprotective measures, and topical steroids, leading to improvement, although UV exposure still triggered flares.