THE EFFECT OF REPLENISHMENT OF IRON STORES AFTER PHLEBOTOMY THERAPY IN PORPHYRIA CUTANEA TARDA

. In a previous study phlebotomy therapy was consistently effective in porphyria cutanea tarda, causing clinical and biochemical remission in all. In 13 patients observed for periods of 1 to 3 1/2 years after treatment and who were not given iron, relapse occurred in only one patient. The latter had reaccumulated iron stores of considerable size spontaneously. In the present study the effect of replenishment of iron stores after phlebotomy-induced remission was investigated. Five patients (4 men and 1 woman) were included, in four of whom the initial iron stores (before phlebotomy) had been of normal size. In one of them a moderate iron overload had been present. Iron stores were replenished by oral administration of iron sulphate in four and by intravenous administration of iron dextrin in one. After replenishment of iron stores biochemical relapse occurred in each patient. The skin disease remained in remission, except in the woman who noted an increased hair growth on the face. They were again subjected to repeated phlebotomy. Biochemical remission occurred in all and the hypertrichosis in the woman vanished. It is concluded that phlebotomy probably exerts its effect by reduction of iron stores, and that even normal amounts of storage iron may provoke deterioration of porphyrin metabolism in subjects with latent disease.