Photosensitive dermatitis from bleaching creams

My friend, David Elpern MD, a dermatologist from Williamstown, USA sent this note to me.

"NY Times
May 14, 2006

A Vision of Pale Beauty Carries Risks for Asia's Women

By THOMAS FULLER

MAKHAM KHU, Thailand - Neighbors gawk and children yell, "Ghost!" The manager of the restaurant where Panya Boonchun worked simply told her she was fired.
The cream that she applied to her face and neck was supposed to transform her into a white-skinned beauty, the kind she saw in women's magazines and on television.
But the illegally produced lotion she bought in a store near this village in southeastern Thailand turned her skin into a patchwork of albino pink and dark brown. Doctors say her condition may be irreversible.
"I never look in the mirror anymore," she said, sobbing during an interview.
Whiter skin is being aggressively marketed across Asia, with vast selections of skin-whitening creams on supermarket and pharmacy shelves testament to an industry that has flourished over the past decade. In Hong Kong, Malaysia, the Philippines, South Korea and Taiwan, 4 of every 10 women use a whitening cream, a survey by Synovate, a market research company, found."

And it so happened the same morning I saw a 33-year-old man who had been applying a bleaching cream from Southern Thailand for his melasma. After several weeks of application, He noticed pigmentary changes on his face which was dusky brownish tinge on the forehead, cheeks and chin. It has now spread to the neck as well. Past one week, he noticed skin eruptions appearing on the forearms as well. He was otherwise well and has no fever or polyarthralgia.
His medication history included OTC garlic pills and fish oil. He is however a heavy drinker.

Examination of the skin showed diffuse dusky erythematous to brownish macules on the patient's ears, face and neck. The eruptions somehow spares the nose. Eczematous eruptions were noted on the forearms bilaterally. There were no hepatosplenomegaly. There were no sclerodactyly changes on the fingers.

My first impression was could this be the "southern thailand bleaching creams ghostly onchronosis due to high concentration hydroquinone cream??

Investigations done showed normal blood counts and blood biochemistry. ANA serology was negative.

I suspect this is some form of photosensitive dermatitis. Porphyria cutanea tarda runs thro my mind as a differential as he is heavy drinker but his LFTs were normal. I have never seen this before.