Large, nonhealing scalp ulcer associated with scarring alopecia and sclerodermatous change in a patient with porphyria cutanea tarda

Porphyria cutanea tardy (PCT) is a disorder caused by deficient activity of a liver enzyme that leads to the accumulation of photoactive metabolites in the skin. The initial clinical presentation commonly includes mechanical fragility of the skin and blisters in sun-exposed areas. Sclerodermatous skin changes and scarring alopecia are described in up to 20% of patients. Although these unique skin changes have been reported in the literature, information regarding nonhealing ulcers of extraordinary size is lacking. We report a unique cutaneous manifestation of PCT that is not well documented: unusually large, nonhealing ulcers in the setting of sclerodermatous skin changes and scarring alopecia.