The cutaneous manifestations begin as areas of erythema with vesicles or bullae that occur on exposed portions of the body. Crusts and scabs develop, followed by scarring. The vesicles and bullae are usually most evident in sunny weather, particularly in late summer and early autumn. In severe untreated cases, disfiguring changes can occur in the ears, nose and fingers. Histologically, the most frequent findings are siderosis and evidence of recurring liver damage.
Some patients have frank cirrhosis.
Liver fluorescene may be demonstrable. Chloroquine produces a reaction in this disease that can include fever, headache, abdominal pain, vomiting and red urine.