Glycyrrhizin May Be Effective in Patients with Alcohol-linked PCT, Case Report Says

Glycyrrhizin may be an effective treatment option for patients who develop porphyria cutanea tarda associated with alcohol abuse, a case report says.

The case report study, “A first report of porphyria cutanea tarda successfully treated with glycyrrhizin,” was published in the journal of Dermatologic Therapy.

Porphyria cutanea tarda (PCT), the most common form of porphyria, is characterized by skin abnormalities (sunlight sensitivity, skin peels or blisters, changes in skin tone, crusts, etc.) caused by low levels of a liver enzyme called uroporphyrinogen decarboxylase (UROD). This enzyme is required for the production of heme — a molecule essential for red blood cells’ oxygen transport and compounds’ breakdown in the liver.

“Multiple susceptibility factors are associated with the exacerbation of PCT, including alcohol abuse, iron overload, smoking, and hepatitis C virus infection,” the authors wrote.

Glycyrrhizin is a compound that can be found in licorice (or liquorice), an extract from the root of the plant Glycyrrhiza glabra. Because of its strong anti-inflammatory and liver protective properties, it has been widely used to treat liver diseases in China and Japan.

In this case report study, Chinese investigators described the case of a man with a history of alcohol abuse whose PCT symptoms significantly improved after receiving treatment with glycyrrhizin.

The 51-year-old complained of having blisters, crusts and skin erosions appearing repeatedly in areas of the skin that had been exposed to sunlight for the past three months leading up to his hospital visit.

Physical examination confirmed he had skin erosions, blisters, crusts and patches of darker skin (hyperpigmentation) on the back of his neck and hands. He had no history of genetic disorders in his family, but he did have a 30-year history of alcohol abuse.

Blood tests revealed elevated levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), and alkaline phosphatase (ALP), suggesting liver inflammation and possibly extensive damage.

Levels of lactate dehydrogenase (LDH, an enzyme whose levels can be used as a readout of red blood cells’ destruction), plasma porphyrin, and urinary uroporphyrin were also elevated, consistent with a diagnosis of porphyria.

Based on his medical history, physical examination and blood test results, the man was diagnosed with PCT. He was started on glycyrrhizin (75 mg three times a day) to protect his liver, instructed to apply sunscreen regularly, and told to stop drinking alcohol. One month later, his skin lesions had improved dramatically, as did his blood test results.

“In the present case, glycyrrhizin is an efficient option for alcohol abuse-induced PCT, as it seems to mediate the [liver protective] effect by inhibiting oxidative stress (cellular damage that occurs as a consequence of high levels of oxidant molecules) and inflammation,” the researchers stated.

“However, there remain certain unsolved issues in this case. These include (a) the interaction of alcohol-induced liver damage and PCT, and (b) mechanism of action of glycyrrhizin in the treatment of PCT. More data from prospective studies are needed to further determine the efficacy of glycyrrhizin in PCT,” they added.