What are porphyrias?
Explanation of medical terms and concepts Porphyria
Types of porphyria
There are several types of porphyria, which are classified into two categories:
- hepatic
- erythropoietic
Symptoms Porphyria
Symptoms associated with hepatic disease include:
- limb pain
- neuropathy
- hypertension
- tachycardia (fast heart rate)
- electrolyte imbalance
Symptoms associated with erythropoietic disease include:
- extreme skin sensitivity to light
- anemia (when the body does not produce enough new red blood cells)
- changes in skin pigmentation
- erratic behavior related to sun exposure
- Mental changes, such as anxiety, confusion, hallucinations, disorientation or paranoia
- Breathing problems
- Urination problems
- Severe abdominal pain
- Pain in your chest, legs or back
- Constipation or diarrhea
- Nausea and vomiting
- Muscle pain, tingling, numbness, weakness or paralysis
- Red or brown urine
- Seizures
- Rapid or irregular heartbeats you can feel (palpitations)
- High blood pressure
Cutaneous porphyrias
As a result of sun exposure, you may experience:
- Sensitivity to the sun and sometimes artificial light, causing burning pain
- Sudden painful skin redness (erythema) and swelling (edema
- Blisters on exposed skin, usually the hands, arms and face
- Fragile thin skin with changes in skin color (pigment)
- Itching
- Excessive hair growth in affected areas
- Red or brown urine
When to see a doctor
Causes Porphyria
- Drinking alcohol
- Estrogen use by women
- Hepatitis C
- HIV
- Smoking
Genetic forms
Most forms of porphyria are inherited. Porphyria can occur if you inherit:
- A defective gene from one of your parents (autosomal dominant pattern)
- Defective genes from both parents (autosomal recessive pattern)
Risk factors Porphyria
- Menstrual hormones ― acute porphyria attacks are rare before puberty and after menopause in women
- Exposure to sunlight
- Certain medications, including hormone drugs
- Recreational drugs
- Dieting or fasting
- Smoking
- Physical stress, such as infections or other illnesses
- Emotional stress
- Alcohol use
Complications
Possible complications depend on the form of porphyria:
- Acute porphyrias can be grievous if Associate in Nursing attack isn't promptly treated. throughout an attack, you will expertise dehydration, respiration problems, seizures and high blood pressure. Episodes usually need hospitalization for treatment. long complications with perennial acute attacks may embody chronic pain, chronic nephrosis and liver damage.
- Cutaneous porphyrias can result in permanent skin damage. Also, the skin blisters will become infected. once your skin heals when cutaneal porphyria, it's going to have an abnormal look and coloring, be fragile, or leave scars.
Prevention
- recreational drugs
- mental stress
- excessive drinking
- certain antibiotics
Preventing erythropoietic symptoms focuses on reducing light exposure by:
- staying out of bright sunlight
- wearing long sleeves, hats, and other protective clothing while outside
- asking for protection during surgery (in rare cases phototoxic injury can occur; this happens when light perforates the organs and leads to infection)
Diagnosis Porphyria
The signs and symptoms of porphyria are similar to those of other more common diseases Because porphyria is rare it can be more difficult to diagnose
Lab tests are required to make a definitive diagnosis of porphyria and determine the form of the disease you have Your doctor will order various tests depending on the form of porphyria he or she suspects These may include blood urine and stool testing
More tests may be needed to confirm the type of porphyria a person has Genetic testing and counseling may be recommended in the family of someone with porphyria
Treatment Porphyria
Treatment depends on the type of porphyria you have and the severity of symptoms Treatment includes identifying and avoiding symptom triggers and then relieving symptoms when they occur
Avoiding triggers
Avoiding triggers may include:
- Avoid using drugs that are known to trigger an attack of acute asthma Ask your doctor for a list of safe and unsafe drugs
- Not using alcohol or recreational drugs.
- Avoiding fasting and dieting that involves severe calorie restriction
- Not smoking.
- Taking hormones to prevent menstrual attacks
- When you're outside wear protective clothing and use a sunscreen that blocks sunlight by using zinc oxide When you are inside use window filters to block harmful UV rays
- Treat infections and other illnesses as soon as possible
- Taking steps to reduce emotional stress.
Acute porphyrias
Treatment for acute porphyria attacks focuses on providing rapid treatment of symptoms and preventing complications Treatment may include:
- Injections of hemin can help limit the body's production of porphyrins Heme is a form of iron that is found in red blood cells
- Glucose or sugar taken by mouth if able to maintain an adequate intake of carbohydrates
- Patients are hospitalized for treatment of symptoms such as severe pain vomiting dehydration or breathing problems
In 2019 the FDA approved givosiran (Givlaari) as a monthly injection for adults with acute hepatic porphyria to reduce the number of porphyria attacks However it is important to discuss safety information and potential serious side effects with your doctor These include but are not limited to: Potential side effects include nausea liver and kidney toxicity and a small risk of anaphylaxis
Cutaneous porphyrias
There are many treatments for cutaneous porphyrias including reducing exposure to triggers such as sunlight and reducing the amount of porphyrins in your body to help eliminate symptoms This may include:
- To reduce the amount of iron in your body we will periodically draw blood (phlebotomy) to remove excess iron This decreases porphyrins and makes it easier for your body to eliminate them
- Taking a drug used to treat malaria — hydroxychloroquine (Plaquenil) or less often chloroquine (Aralen) — to absorb excess porphyrins and help your body get rid of them more quickly than usual These medications are generally used only in people who can't tolerate a phlebotomy
- A dietary supplement to replace vitamin D deficiency caused by avoidance of sunlight
Lifestyle and home remedies
If you have porphyria:
- Learn what could trigger symptoms.Speak to your doctor about the type of porphyria you have and learn about possible triggers and ways to avoid them
- Inform your health care providers.Keep your health care providers informed about your porphyria This is particularly important because some treatments medications or operations may trigger porphyria symptoms
- A medical alert bracelet or necklace is wornHave information about your condition inscribed on a medical alert bracelet or necklace and always wear it
Coping and support
Porphyria is considered a chronic condition because the underlying cause cannot be cured However porphyria can usually be managed by treatment and lifestyle changes so that you can live a full healthy life
Preparing for your appointment
If you are suspected of having porphyria your primary care provider may go to see you first However since porphyria can be difficult to diagnose you may be referred to a doctor who specializes in blood disorders (hematologist)
The following information can help you prepare for your appointment Here are some things you can expect from your doctor
What you can do
Before your appointment, make a list of:
- If you are experiencing any symptomsincluding any information that may seem unrelated to the reason you have made an appointment
- Key personal information,including any major stresses or recent life changes
- All medications,vitamins and other supplements that you're taking including dosages
- Questions to ask your doctor
Here are some questions to ask your doctor:
- What's the most likely cause of my symptoms?
- What are other possible causes?
- What kinds of tests do I need?
- What's the best course of action?
- Are there other ways to do this?
- I have another health condition How can I best manage these together?
- Are there any precautions or restrictions I should follow?
- Do I need genetic testing? If so should my family members be screened?
- Do you have any brochures or other printed material that I can have? What websites do you recommend?
You may ask other questions during your appointment
What to expect from your doctor
Your doctor is likely to ask you several questions Before the appointment think about what your goals are and jot down some notes so that you have time to focus on the areas you want to discuss when the doctor asks his questions Some questions your doctor may ask include:
- When did you notice the first symptoms?
- Have you experienced these symptoms continuously or occasionally?
- If you have a symptom what can make it better?
- What makes your symptoms worse?
- Do you have any family members with similar symptoms?
General summary
and Hemochromatosis Facts Hemochromatosis (HH) is also known as iron overload disease It stems from an inherited liver disorder where the body absorbs too much iron which can lead to organ damage and even death This condition causes the affected person's system to absorb more iron than it should The excess iron becomes toxic in cells and tissues throughout the body In people with HH their bodies are unable to remove or process excessive amounts of dietary iron leading them to develop this disease Each year there are about 10,000 new cases diagnosed with hemochromatosis in the U.S. causing
inducers Porphyria is a group of rare metabolic disorders that produce toxic substances in the body Symptoms result from exposure to substances called porphyrins and/or other chemicals or medications Individuals with porphyria may develop skin rashes abdominal pain vomiting muscle weakness and psychiatric symptoms such as disorientation (forgetfulness) agitation and hallucinations (seeing or hearing things that are not real) Some forms of porphyria cause urine to turn blue-green when it contacts air The following list contains inducers (agents) of porphyria: Acetaminophen (e.g. Tyl
What is porphyria?
Porphyria is a group of disorders that involve the overproduction of porphyrins which are naturally occurring chemicals found in red blood cells Porphyrins are responsible for making hemoglobin (the substance in red blood cells that delivers oxygen throughout the body) In patients with porphyrias the liver combines certain substances called precursors into these chemicals too quickly When this happens an excess of porphyrins builds up in the bloodstream and can cause health problems
How does porphyria manifest?
Porphyria is a group of rare disorders that causes severe health problems on the skin nervous system and gastrointestinal tract The symptoms of porphyria are caused by the body's inability to produce a key enzyme needed to make heme or red blood cells There are different types of porphyrias based on which enzyme is affected
porphyria cutanea tarda
Porphyria cutanea tarda (PCT) also known as cutaneous porphyria is a rare disorder of the blood and liver The symptoms often start appearing slowly with easy bruising or discolouration of the skin Later on hair growth can be altered and scalp hair may fall out in patches More severe cases of PCT involve damage to the nervous system where it may lead to memory loss and organ damage This condition mostly affects adults over age 30 but can appear even in children and infants
How to treat porphyria?
Although porphyria is a chronic condition with recurrent attacks treatment can control symptoms and prevent future attacks Some people may never need to be treated because their symptoms are mild or infrequent For those who do need a medication regimen it will likely include medications for both the acute attack and for prophylaxis (preventing further attacks) Acute medications are always taken during an attack Prophylactic medications can be used daily as well as just before expected triggers that cause an attack such as menstruation or exposure to sunlight Medications vary by individual Patients should work with their doctors to develop the most effective
How to detect porphyria?
There are several tell-tale symptoms of porphyria the most common of which is abdominal pain It may feel like a severe cramp that comes on suddenly and then disappears just as fast Additional early warning signs include fatigue or mental confusion especially in combination with stomach problems Other reported symptoms of porphyria include stomach-related issues such as vomiting or diarrhea; frequent urination; sensitivity to sunlight and/or skin rashes such as acne itching or hives In rare cases when an acute attack has occurred patients may have seizures black out or become comatose Longer term effects can also occur for.