C.Y. Zhao , J.W. Frew , J. Muhaidat , P. Lee , V. Poulos , I. McCrossin , , A.R. Cachia , F. Tefany , , D.F. Murrell
Background: Chlorophyll is a photosynthetic molecule
found in green leafy plants. It has been promoted and
widely sold as an over-the-counter “detoxiﬁcation” supplement
Results: We report 5 cases of chlorophyll-induced
pseudoporphyria with symptoms of skin fragility, blisters,
erosions, paraesthesia and/or oedema in sun-exposed
areas, especially the dorsa of arms and hands. The 5 cases
had mean symptom duration of 24 months prior to presentation,
self-medicating with a mean volume of 30 ml of
chlorophyll daily. Biopsies of 3 of 3 patients revealed a
subepidermal blister with pauci-inﬂammatory inﬁltrate
characteristic of pseudoporphyria. Direct immunoﬂuorescences
of 2 of 2 patients showed immunoglobulins
near vessels and epidermis, but indirect immunoﬂuorescence
studies were negative. Porphyrin testing showed
marginally elevated porphyrin levels in the red blood cells
of 2 patients and faeces of 1 patient, but not in the urine of
any patients. All patients were advised to cease chlorophyll.
Although there was variable symptomatic improvement, 3
of 5 patients reported ongoing paraesthesia and skin fragil-
ity up to 8 months after cessation.
Discussion: This is the largest series of chlorophyll-induced
pseudoporphyria, and the ﬁrst to report ongoing photosensitivity
after chlorophyll cessation. In this presentation, we
review previously reported cases of chlorophyll-induced
cutaneous symptoms. We also discuss animal studies
showing that the chlorophyll metabolites pheophorbide-a,
pyropheophorbide-a and phytoporphyrin may be responsible
for chlorophyll-induced photosensitivity.
We speculate that prolonged half-life or binding of chlorophyll metabolites in the blood, skin or liver of genetically or metabolically susceptible patients may cause persistence of symptoms well after chlorophyll cessation.