What are the symptoms of Porphyria?
Acute porphyrias are characterised by attacks of pain and other signs of neurological distress.
In cutaneous porphyrias, the build-up of porphyrins and porphyrin precursors interacts with ultraviolet light from sun exposure to cause your skin to become very sensitive to light. The most common type of this is called Porphyria cutanea tarda or (PCT).
Symptoms do not usually appear until well after puberty and are seen more in women than in men (and more likely to occur during menstruation). The majority of people who inherit the disorder do not have attacks. Where symptoms do occur, they are sudden and can last for days or weeks.
Attacks of acute porphyria may unfold or progress with the following symptoms:
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anxiety, restlessness and insomnia
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severe abdominal pain
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pain in your arms, legs or back
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vomiting and constipation
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high blood pressure (hypertension)
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muscle pain, tingling, numbness, weakness or paralysis
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confusion, hallucinations and seizures
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breathing difficulties (respiratory paralysis), possibly requiring ventilation
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reddish coloured urine.
Acute attacks happen when the levels of porphyrins in your body become very elevated (increased).
They range in severity and usually require having to go to hospital. In the worst case they may require emergency procedures to prevent death.
Whatever the severity of your attacks, it is essential that medical staff act quickly to ensure you receive the appropriate medical treatment.
There is considered to be a slightly increased risk of having an acute attack during or following pregnancy. This risk is reduced if the porphyria you have is already diagnosed and most pregnancies don’t result in problems.
Cutaenous porphyrias and neurocutaneous porphyrias
The symptoms of cutaneous porphyrias and neurocutaneous porphyrias usually appear quickly following exposure to the sun. They usually take the following forms:
- itching (pruritus)
- painful skin redness
- skin swelling
- blistering (though not associated with EPP)
- abnormal hair growth on the face can sometimes occur
- reddish coloured urine.
Skin exposed to sunlight is likely to become very fragile, where even slight contact may cause injury to your skin. Areas most at risk are those more commonly exposed, such as your face, neck, hands and feet. In some cases this can lead to permanent skin damage.
A combination of porphyria cutaneous tarda and chronic liver damage may place a person at much higher risk of developing liver cancer, known as hepatocellular carcinoma (HCC).
Treatment for porphyria
There is no cure for porphyria. Treatment is aimed at getting rid of or managing your symptoms.
Only drugs known to be safe in porphyria can be prescribed for treatment, as many medications, including common sleeping pills and antibiotics can trigger acute attacks. This underlines the importance of making others aware that you have the condition, and the specific form.
Treatment of cutaneous porphyrias include:
Treatment of cutaneous porphyrias is aimed at reducing the amount of porphyrins in your body to help eliminate your symptoms. This may include:
- phlebotomy, also called venesection, a procedure similar to that used for blood donation in which a quantity of blood (usually up to 500 millilitres) is drawn into a blood donation bag via a needle placed in a vein in your arm. It is carried out to reduce the amount of iron in your body. Phlebotomy is most commonly used for PCT.
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blood transfusion, the opposite treatment to phlebotomy. This is used for CEP in order to treat anaemia, in which you lack enough red blood cells.
- a low dose of chloroquine, a drug given in tablet form twice a week.
- beta carotene, given daily for EEP. Made from the orangey-yellow pigment that gives many fruits and vegetable their colour, beta carotene is converted by the body into vitamin A, to promote healthy skin and eyes and to increase your skin’s tolerance to sunlight. It may also colour your own skin a slight orangey shade.
- a bone marrow transplant may be required for people with CEP, where the abnormal gene involved may also affect the formation of bone marrow.
Further Information
Diet and exercise when you have porphyria
There is no specific diet recommended for porphyria disorders other than eating healthily and making sure meals are taken regularly. This is more important for people who have acute porphyria as they are more sensitive to the effects of certain foods and beverages. This means keeping up a steady intake of calories by eating plenty of carbohydrates.
People who have acute porphyrias commonly suffer fatigue. This may be due to symptoms affecting muscles and joints (such as pain, numbness and weakness) and the sleep disturbance this may cause. In some cases the effects of medication used to control symptoms may contribute to bouts of tiredness.
It is important that your muscles do not get out of condition or reduce in size (atrophy). For this reason it is likely doctors will encourage you to follow a daily exercise routine or to take part in moderate physical activity a few days a week to keep your muscles in shape and to help you sleep better.
Support when you have porphyria
Please visit the support section of our website for information on Support groups in your area or visit our Useful Links section for other organisations who may be able to offer information and support. Other organisations that may be able to offer further information are:
British Porphyria Association (BPA)
Tel: 0300 30 200 30
Email: helpline@porphyria.org.uk
Web: www.porphyria.org.uk
The Drug Database for Acute Porphyria
Web: www.drugs-porphyria.org
Please visit the support section of our website for information on Support groups in your area.