There are two general categories of porphyria — acute, which mainly affects the nervous system, and cutaneous, which mainly affects the skin. Some types of porphyria have both nervous system symptoms and skin symptoms, and others have mainly one or the other.
Acute porphyrias include forms of the disease that typically cause nervous system symptoms, which appear quickly and can be life-threatening. Acute porphyria attacks are rare before puberty and after menopause in women. Symptoms may last one to two weeks and usually improve slowly after the attack.
Possible signs and symptoms of acute porphyria include:
- Severe abdominal pain
- Swelling of the abdomen (abdominal distention)
- Pain in your chest, legs or back
- Constipation or diarrhea
- Heartbeat you can feel (palpitations)
- High blood pressure
- Anxiety or restlessness
- Mental changes, such as confusion, hallucinations, disorientation or paranoia
- Breathing problems
- Muscle pain, tingling, numbness, weakness or paralysis
- Red or brown urine
Cutaneous porphyrias include forms of the disease that cause skin symptoms as a result of oversensitivity to sunlight, but these forms don't usually affect your nervous system. Attacks may last for several days. With some forms, signs and symptoms may start during infancy or childhood.
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 that take weeks to heal
- Fragile skin
- Scars or skin color changes from healing blisters
- Increased hair growth
- Red or brown urine
When to see a doctor
Many signs and symptoms of porphyria are similar to those of other, more common conditions. This can make it difficult to know if you're having an attack of porphyria. Any of the following symptoms should prompt you to seek immediate medical attention:
- Severe abdominal pain, but sometimes pain in your chest, legs or back, accompanied by constipation, vomiting and sometimes diarrhea
- Sensitivity to the sun and sometimes artificial light, causing burning pain and sudden painful skin blistering, redness (erythema) and swelling (edema)
- Red or brown urine
Porphyria is most often an inherited mutation in one of the genes involved in heme production, although environmental factors can trigger symptoms in some cases.
Heme is a major component of hemoglobin, the protein in red blood cells that carries oxygen from your lungs to all parts of your body. Heme also plays a role in breaking down chemicals so they can be removed from your body. Heme is made mainly in the bone marrow and liver through the production of porphyrin and linkage with iron.
Eight different enzymes add and convert natural, smaller building blocks into porphyrin, which becomes heme with the addition of iron. Deficiency of a specific enzyme that's involved in the body's process for making heme can result in the buildup of porphyrins, causing symptoms. Each type of porphyria is due to the deficiency of a different enzyme.
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)
Just because you have inherited a gene or genes that can cause porphyria doesn't mean that you'll have signs and symptoms. You might have what's called latent porphyria, and never have symptoms. This is the case for most carriers of the abnormal genes.
In addition to genetic risks, environmental factors may trigger the development of signs and symptoms in some types of porphyria. When exposed to the trigger, your body's demand for heme production increases. This overwhelms the deficient enzyme, setting in motion a process that causes signs and symptoms. Examples of triggers include:
- Certain drugs (barbiturates or sulfonamide antibiotics or, less often, birth control pills, or some drugs that affect the mind or behavior, known as psychoactive drugs)
- Dieting or fasting
- Physical stress, such as infections or other illnesses
- Liver disease
- Emotional stress
- Alcohol use
- Menstrual hormones
- Sun exposure
- Excess iron in your body
Possible complications of porphyria include:
- Dehydration. Vomiting due to an attack of acute porphyria can lead to dehydration, which may require that you receive fluids through a vein (intravenously).
- Breathing difficulties. Acute porphyrias can cause muscle weakness and paralysis, which can cause breathing problems. If left untreated, they can also lead to respiratory failure.
- Low sodium in your blood. Called hyponatremia, this is usually linked to problems with sodium and water handling in your body.
- High blood pressure. Porphyrin buildup can damage your kidneys and may result in high blood pressure (hypertension).
- Chronic kidney failure. Porphyrin buildup may cause your kidneys to gradually lose their ability to function.
- Liver damage. Some forms of porphyria cause excessive porphyrins in your liver, which may lead to severe liver damage that can eventually require a liver transplant.
- Permanent skin damage. When your skin heals after cutaneous porphyria, it may have an abnormal appearance and coloring. Scars may remain on your skin as well, and lasting skin problems may cause your hair to fall out.
Although there's no way to prevent porphyria, if you have the disease, these steps may help prevent symptoms:
- Avoid medications known to trigger acute attacks. Ask your doctor for a list of safe and unsafe drugs.
- Don't use alcohol or illegal drugs.
- Avoid fasting and dieting that involves severe calorie restriction.
- Don't smoke.
- Minimize sun exposure. When you're outdoors, wear protective clothing and use a broad-spectrum sunscreen with a high sun protection factor (SPF).
- Treat infections and other illnesses promptly.
- Take steps to reduce emotional stress.
Because porphyria is an inherited disorder, your siblings and other family members may want to consider genetic testing to determine if they have the disease.