Blisters on the hands of a man with darkened urine

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This 45-year-old man with a history of hepatitis C and cirrhosis presented with tense blisters that had been present on the backs of his hands for the past year. Blistering was worse in summer and after sun exposure. Increased hair growth on his face as well as diffuse facial hyperpigmentation and skin thickening were also noted. The patient’s urine, viewed in the office under a Wood’s lamp, displayed coral-pink fluorescence compared with the lack of fluorescence seen in the control specimen.

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