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A 3 year old girl with juvenile idiopathic arthritis (JIA) presented with recurrent blisters over the cheeks and nose which were initially treated as impetigo with flucloxacillin. Despite this, new blisters continued to appear which evolved into punched out lesions and healed with scars. She had been treated with naproxen 125 mg/day for six months. This is pseudoporphyria, an uncommon but well recognised side effect of non-steroidal anti-inflammatory drugs (NSAIDs), with cutaneous features in photosensitive areas indistinguishable from porphyria, but without the metabolic porphyrin abnormalities.1 The incidence of pseudoporphyria may be as high as 10% in children taking NSAIDs for JIA.1,2 Naproxen is the most common culprit, but the condition has been reported with other NSAIDs.3–7 Stopping the naproxen ceased the new blister formation and the ulcers healed, but faint scars remain. It is important for paediatricians to be aware of this disfiguring side effect of frequently prescribed drugs, as discontinuing the drug produces resolution.8
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