We measured uroporphyrinogen decarboxylase (UROD) activity in erythrocyte lysates obtained from 40 consecutive patients with porphyria cutanea tarda (PCT) without selection for family history. Enzyme determinations indicated that 28% of the patients had abnormally decreased UROD activity in erythrocytes; this finding did not always correlate with family history. Two siblings with PCT and normal erythrocytic, but abnormally decreased hepatic UROD activities, were encountered. This finding suggests that familial PCT may occur not only with decreased erythrocyte UROD activity, but also with a normal UROD activity in erythrocytes.

Incorrect diagnosis of photoallergy to sunscreen products represents a unique clinical dilemma. Increasing sunscreen usage for suspected idiopathic photosensitivity or a change to a sunscreen containing the same photoallergen only worsens the problem. While photoallergy to p-aminobenzoic acid and its esters is well known by dermatologists and the lay public, benzophenone photoallergy is not well appreciated. We report herein the cases of four individuals with photoallergy to oxybenzone in sunscreens. It is likely that such reactions will become more commonplace since oxybenzone is by far the most frequently used agent in modern, high sun protection factor sunscreens (greater than 8 sun protection factor) being marketed today.

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A 46-year-old homosexual man with disseminated histoplasmosis and human immunodeficiency virus (HIV) infection had a histoplasmosis-related ulcerated verrucous plaque above his left upper lip; systemic and cutaneous disease manifestations of histoplasmosis resolved with daily ketoconazole therapy. Disseminated histoplasmosis, with similar cutaneous features, also was present in his HIV-seropositive male sexual partner. The possibility of human-to-human transmission of histoplasmosis between these patients is considered and the skin lesions of systemic fungal infections in HIV-infected patients are reviewed.