Improvement in ocular cicatricial pemphigoid following treatment for porphyria cutanea tarda

A 64-year-old Caucasian male complaining of redness and tearing for 3 years in both eyes was referred for evaluation of cicatricial conjunctivitis. Ocular cicatricial pemphigoid was suspected and this diagnosis was confirmed through biopsy. The patient’s condition showed moderate improvement following treatment with methotrexate and mycophenolate mofetil. The patient was later diagnosed with porphyria cutanea tarda and phlebotomy treatments were subsequently initiated. The patient’s ocular symptoms improved further after he began receiving these phlebotomy treatments, and conventional treatment was discontinued. The authors hypothesize that circulating porphyrins activated by ultraviolet light could be the cause of the ocular cicatricial pemphigoid in this patient.