Porphyria – Types, Causes, Symptoms Treatment and Prognosis
PORPHYRIA
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Last Updated : 10/1/2014
Jagdish Kathwate
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What is Porphyria?
Porphyria is a group of disorders that can cause nerve or skin problems. A porphyria that affects the skin is called cutaneou porphyria. A porphyria that affects the nervous system is called acute porphyria.
The most common type of porphyria is porphyria cutanea tarda (PCT), which affects the skin. PCT is also the most treatable.

What are Symptoms of Acute Porphyria?
The symptoms of acute porphyria can develop quickly and last for days or weeks. A salt imbalance sometimes accompanies an episode of this type of porphyria. The imbalance can contribute to some of these symptoms:
- Chest pain
- Abdominal pain, often severe
- Increased heart rate and blood pressure
- Limb and back pain
- Muscle weakness
- Tingling
- Loss of sensation
- Cramping
- Vomiting and constipation
- Personality changes or mental disorders
- Agitation, confusion, and seizures
Long-term complications in some patients have included:
- Chronic pain
- Depression
- Kidney damage
- Liver cancer

What are Symptoms of Cutaneous Porphyria
Symptoms of cutaneous porphyria occur when the skin is exposed to sunlight. The most commonly affected areas include the back of the Hands, Forearms, Face, Ears and Neck.
The symptoms include:
- Blisters
- Itching
- Swelling of the skin
- Pain
- Increased hair growth
- Darkening and thickening of the skin

What are Causes of Porphyria
Each type of porphyria has the same root cause -- a problem in the production of heme. Heme is a component of hemoglobin. That's a protein in red blood cells that carries oxygen from the lungs to the rest of the body.
Heme contains iron and gives blood its red color. The production of heme takes place in the liver and bone marrow and involves eight different enzymes. A shortage of any of those enzymes can create an excess buildup of certain chemical compounds involved in producing heme. The specific type of porphyria is determined by which enzyme is lacking.
Most types of porphyria are inherited. About half of them occur when one altered gene is passed from just one parent. The risk of developing a porphyria or passing it to your children depends on the specific type.

Porphyria cutanea tarda on the other hand, is often an acquired disease. Although the enzyme deficiency that causes PCT can be inherited, most people who inherit it never develop symptoms. Instead, the disease becomes active when the deficiency is triggered by certain conditions or lifestyle choices. These include:
- Drinking alcohol
- Excessive intake of iron
- Hepatitis C
- HIV
- Smoking

Episodes of acute porphyria, which very rarely occur before puberty, can be triggered by some drugs. These include:
- Barbiturates
- Tranquilizers
- Birth control pills
- Sedatives
Other potential triggers include:
- Fasting
- Smoking
- Drinking alcohol
- Infections
- Menstrual hormones
- Stress
- Sun exposure

What is treatment for porphyria?
Some of the medicines used to treat a sudden (acute) attack of porphyria may include:
- Hematin given through a vein (intravenously)
- Pain medication
- Propranolol to control the heartbeat
- Sedatives to help you feel sleepy and less anxious
Other treatments may include:
- Beta-carotene supplements
- Chloroquine
- Fluids and glucose to boost carbohydrate levels, which helps limit the production of porphyrins
- Removal of blood (phlebotomy)
Depending on the type of porphyria you have, your doctor may tell you to:
- Avoid all alcohol
- Avoid drugs that may trigger an attack
- Avoid injuring the skin
- Avoid sunlight as much as possible and use sunscreen when outside
- Eat a high-carbohydrate diet

What is Prognosis?
Porphyrias are life-long diseases with symptoms that come and go. Some forms of the disease cause more symptoms than others. Proper treatment and avoidance of triggers can help prolong the time between attacks.
When to Contact a Medical Professional?
Seek medical attention as soon as your child has signs of an acute attack. Talk to your doctor about your risk for this condition if you have a long history of undiagnosed abdominal pain, muscle and nerve problems, and sensitivity to sunlight.

How to prevent?
Genetic counseling may benefit people who want to have children and who have a family history of any type of porphyria.



Contributor Information and Disclosures

Jagdish Kathwate
MD Pediatrics. Assistant Professor, Government Medical College, Aurangabad, India.


First Created : 2/28/2001
Last Updated : 10/1/2014

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