To the Editor.—
In his letter, the late Dr Reed1 poses three basic problems in acquired2 or symptomatic3 (hepatic) porphyria cutanea tarda (PCT-S), viz, (1) causes of, (2) predisposition to, and (3) inheritance of the disease. First, there has been an increase in the factors that cause PCT-S, or in the precipitating agents in predisposed individuals. Synthesis of porphyrins occurs in the liver cell where chemical compounds, such as drugs, are converted or detoxified. Aberrations in the porphyrin synthesis, and subsequently in the excretion, may therefore be regarded as disturbance of the liver function, with PCT-S as a clinical manifestation.2Conceivably, the incidence of PCT-S will be increased by the intensified use of alcohol, oral contraceptives, drugs—with possible cross-reaction, eg, of the "caines," (unpublished data), and very likely, also by increased environmental chemical waste-products, such as lead in fish or in gasoline fumes and phenol compounds.4
Tio TH. Causes and Genetic Predisposition in Porphyria Cutanea Tarda. Arch Dermatol. 1978;114(1):129–130. doi:10.1001/archderm.1978.01640130087039
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