<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 42-year-old woman comes to the physician with a rash on the dorsal surfaces of her hands and feet for the past month. The rash began as blisters that developed a few days after she had been sunbathing on the beach. Photographs of the rash are shown. She has no history of similar symptoms, takes no medications, and has no history of recent travels. She has consumed excess alcohol several times over the past 2 months. Her temperature is 37.1C 98.8F. The remainder of the physical examination shows no abnormalities. Laboratory studies show elevated plasma porphyrins, with normal urinary 5-aminolevulinic acid and porphobilinogen. Which of the following is the most appropriate next step in management?? A: Afamelanotide, B: Carbohydrate loading, C: Intravenous hemin, D: Phlebotomy, E: Splenectomy,  <response>: This is a patient with a rash that started after sun exposure, along with elevated plasma porphyrins and normal urinary porphyrin precursors. This presentation is most consistent with porphyria cutanea tarda PCT, a disorder of heme biosynthesis caused by decreased uroporphyrinogen decarboxylase activity. The next step in management is to treat the underlying disorder causing the porphyrin accumulation. In PCT, this is often due to iron overload or hepatitis C infection. The most appropriate next step is phlebotomy to reduce iron stores. Afamelanotide is used to prevent phototoxicity in erythropoietic protoporphyria. Carbohydrate loading prevents attacks in acute intermittent porphyria but is not used to treat PCT. Intravenous hemin can treat acute attacks but is not first-line therapy. Splenectomy may be considered in hereditary hematochromatosis but is not indicated in PCT.D: Phlebotomy 