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Lecluse ALY, Kuck-Koot VCM, van Weelden H, Sigurdsson V, Russel IM, Frank J, Pasmans SGMA. Erythropoietic protoporphyria without skin symptoms-you do not always see what they feel. Eur J Pediatr 2008; 167:703-6. [PMID: 17710435 PMCID: PMC2292482 DOI: 10.1007/s00431-007-0557-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Accepted: 06/18/2007] [Indexed: 10/27/2022]
Abstract
Erythropoietic protoporphyria (EPP) is an inherited disorder of the porphyrin metabolism that often remains undiagnosed in children. We report on a 4-year-old girl who had been suffering for 1 year from recurrent painful crises affecting her hands, feet, and nose following sun exposure. Objective skin lesions were absent until the age of 6. Porphyrin analysis revealed elevated free erythrocyte protoporphyrin (FEP) levels confirming the diagnosis of EPP. This illustrates that skin lesions might be completely absent in children affected with EPP, a fact that has only been reported once previously. Because EPP can manifest with few and unspecific cutaneous symptoms or no skin lesions at all, like in this patient, the diagnosis of EPP might be delayed or missed. EPP should be excluded in all photosensitive children, especially when discomfort is disproportionate to the extent of the cutaneous lesions. The clinic, pathophysiology, diagnosis, complications, and therapy of EPP are discussed.
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Affiliation(s)
- Anne L. Y. Lecluse
- Department of Dermatology and Allergology, Wilhelmina Children’s Hospital, University Medical Centre, G02.124, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Veronica C. M. Kuck-Koot
- Department of Dermatology and Allergology, Wilhelmina Children’s Hospital, University Medical Centre, G02.124, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Huib van Weelden
- Department of Dermatology and Allergology, Wilhelmina Children’s Hospital, University Medical Centre, G02.124, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Vigfus Sigurdsson
- Department of Dermatology and Allergology, Wilhelmina Children’s Hospital, University Medical Centre, G02.124, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Ingrid M. Russel
- Department of Pediatrics, Wilhelmina Children’s Hospital, University Medical Centre, G02.124, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Jorge Frank
- Department of Dermatology, University Hospital Maastricht, Maastricht, The Netherlands
- Maastricht University Centre for Molecular Dermatology (MUCMD), University Hospital Maastricht, Maastricht, The Netherlands
- Euregional Porphyria Centre Maastricht-Aachen (EPCMA), University Hospital Maastricht, Maastricht, The Netherlands
| | - Suzanne G. M. A. Pasmans
- Department of Dermatology and Allergology, Wilhelmina Children’s Hospital, University Medical Centre, G02.124, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
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Abstract
Studies in bacteria, animals and humans have demonstrated that carotenoid pigments can prevent or lessen photosensitivity by endogenous photosensitizers such as chlorophyll or porphyrins, as well as by exogenous photosensitizers such as dyes (e.g., toluidine blue) or porphyrin derivatives. The carotenoids beta-carotene and canthaxanthin have been found to be effective in the treatment of the photosensitivity associated with EPP and certain other photosensitivity diseases. No serious toxicity has been reported from their use, although the use of canthaxanthin is not recommended because of its propensity to form retinal granules. The pigments perform their protective function by quenching excited species formed by the interaction of porphyrins or dyes, light and air, thereby preventing the cellular damage which leads to the symptoms of photosensitivity.
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Affiliation(s)
- M M Mathews-Roth
- Channing Laboratory, Harvard Medical School, Boston, Massachusetts 02115
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