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Porphyria: Causes, Symptoms, Treatment, and Cost

Last Updated: Jul 07, 2023

What is porphyria?

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Porphyria is basically a group of rare metabolic diseases (or disorders) that affect the skin and internal organs, such as the nervous system. These disorders are mainly caused by an enzyme deficiency. The enzyme deficiencies may stem from a number of different causes, which makes the symptoms and severity of different porphyria diseases vary greatly.

Porphyrias is also caused by a genetic disorder that is passed down from parent to child, and most of the porphyrias are inherited in an autosomal dominant manner. The deficiency of an enzyme called uroporphyrinogen decarboxylase results in a buildup of porphyrins, which is a substance that causes the disease.

Treatment of these diseases depends on their severity and causes. In other words, porphyria is a group of rare and potentially life-threatening disorders of the nervous system and skin. Porphyria symptoms may include (but are not limited to) abdominal pain and cramps, constipation, depression, fatigue, muscle and joint pain, memory loss, and seizures.

To understand this better, we can call porphyria a group of disorders that occur when there is a buildup of natural chemicals that are responsible for producing porphyrin in the body. Porphyrins, a group of organic compounds, are essential for the function of hemoglobin, which is a protein found in red blood cells.

Porphyrins are essentially biochemical compounds found in all humans, animals, plants, and bacteria. They are the final product of the heme synthesis pathway and are often referred to as 'heme.' Hemes are organic chemical compounds that belong to the larger group of iron-containing metalloproteins.

In humans, almost all porphyrins are made in the liver and are contained in blood and other body fluids. Hemes are found in every tissue of the body and play a role in many critical functions, including oxygen transport as well as DNA synthesis, cell signaling, and other metabolic processes.

Summary: Porphyria is a group of rare hereditary disorders of the metabolism. The word porphyria comes from the Greek porphyra, which means 'purple,' a reference to the color of urine in some of the diseases. Porphyrias, in a nutshell, are potentially life-threatening acute or chronic disorders of the skin or internal organs.

Types of porphyria

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Porphyrias are classified primarily into two types:

Acute porphyrias:

Acute porphyrias are mainly caused by enzyme deficiencies that must be corrected with the avoidance of triggers and the use of supportive medications (alkaptonuria and porphobilinogen deficiency).

Acute porphyria is more severe and life-threatening than cutaneous. They mostly stem from problems pertaining to hemoglobin production. They can be determined by the symptoms and by simple blood tests.

Acute Porphyria is acute in nature, where the patient suffers from severe pain in the arms and legs and gastrointestinal problems. The symptoms of acute porphyria may last for weeks or months. These symptoms can be many a time confused with the symptoms of malaria, so the patients may be misdiagnosed at times.

Acute porphyrias include acute intermittent porphyria (AIP) and variegate porphyria (VP). Furthermore, it must be noted that both of these porphyrias are rare.

Cutaneous porphyrias:

Cutaneous porphyrias are a group of rare genetic disorders that lead to sensitivity to light. These disorders are characterized by abnormal production of a porphyrin in the skin, resulting in symptoms and pigmentation.

The different types of cutaneous porphyrias are: erythropoietic protoporphyria (EPP), erythropoietic protoporphyria (EPP), variegate porphyria (VP), and congenital erythropoietic porphyria (CEP).


What causes porphyria?

Porphyria is a group of diseases that may come under the influence of genetics, diet, and other factors. These diseases are mainly caused by an increase in porphyrins in the body, leading to various symptoms. The symptoms of porphyria diseases are usually seen in the skin, nerves, and muscles, as well as in the digestive system.

The symptoms of the disease are visible when the level of porphyrins is increased in the bloodstream. The symptoms of different kinds of porphyria disorders may include (but are not limited to) abdominal pain, a speech disorder, dizziness, constipation, sensitivity to sunlight, spasms, and muscle pain.

What are the symptoms of porphyria?

Porphyria symptoms may vary depending on the type of porphyria the patient has. For example, symptoms of acute porphyrias (a severe type of porphyria that is often fatal) include severe abdominal or back pain, vomiting, diarrhea, sensitivity to sunlight, and mental disturbances. On the other hand, symptoms of cutaneous porphyrias (a milder form of porphyria) include easy bruising and purple discoloration of the skin, which most commonly affects the face, arms, legs, and buttocks, as well as abdominal pain.

Porphyria is a group of rare, genetic diseases that occur when the body is deficient in the enzymes needed to break down the amino acids porphyrin and porphobilinogen. Porphyria can cause a variety of difficulties, including extreme photosensitivity, psychiatric problems, excessive hair growth, muscle weakness, liver dysfunction, nerve pain, and even paralysis.

What are the risk factors for porphyria?

Any patient with a family history of porphyria is at risk for developing the disease. One of the reasons for the high prevalence of the disease among people with a family history is the fact that many of them do not realize that they have the gene. Moreover, it is rare for someone to develop porphyria without a family history of the disease.

Apart from genetic risks, porphyria may also develop from exposure to certain environmental triggers. These triggers cause a person's body to increase its demand for heme production, which in turn creates a deficiency of the enzyme needed to produce porphyrins. This can result in a buildup of porphyrins in the body.

Examples of such triggers may include:

  • Smoking
  • Excessive fasting or dieting
  • Physical or emotional stress
  • Recreational drugs
  • Certain medications (especially hormone drugs)
  • Alcohol consumption
  • Menstrual hormones
  • Exposure to sunlight

Finally, it should also be noted that women are at a higher risk of the disease than men.

Summary: According to the National Institute of Health, people with a family history of porphyria, people with liver or gallbladder disease, and people who drink excessive amounts of alcohol are at a higher risk of developing porphyria. Having said that, 70% of people with porphyria have a genetic mutation.

How can you prevent porphyria?

Certain drugs may trigger episodes of acute porphyria, including barbiturates, most antidepressants, and some antibiotics. So, anyone who is at a higher risk of developing this rare condition must stay away from these triggers. Also, some diuretics can trigger attacks, as can certain hormones, which include testosterone and estrogen.

Furthermore, it should be noted that a low-carbohydrate diet may help those who suffer from acute porphyrias. Apart from that, one should also avoid smoking and drinking as much as possible to protect themselves from the risk of developing any of the porphyria diseases.


Porphyria is a group of rare genetic disorders that are mostly passed from parent to offspring. Some people may be at a higher risk of developing this disease because someone in their close family or any of their first-degree relatives already has it. So, if you have a family history of porphyria, you may want to try to maintain a healthy lifestyle in order to help prevent this disease.


You should avoid consuming specific food items that may trigger your body to manifest the symptoms of porphyria. The items that could trigger the disease are as follows:

  • Alcohol
  • Caffeine
  • Nicotine (all sources),
  • Barbiturates
  • Anticonvulsants

If you avoid everything on the above list, you might have no problem staying in good health.

Porphyria: diagnosis and tests

Porphyrias are genetic metabolic disorders. They can be diagnosed by enzyme testing, genetic testing, or certain other tests. Also, a complete medical history and physical examination of the patient are required in most cases.

The patient should also be tested for any medications or substances they have taken that could have triggered porphyria. This can involve checking a patient's current medications, reviewing their medical history, and occasionally performing a urine drug screen or hair analysis. Those who think they might have porphyria should see a specialist, such as a dermatologist, who may order blood tests to check for signs of the disease.

What are the possible complications of porphyria?

Porphyria is a condition in which red blood cells break down too rapidly. This can result in a buildup of a chemical called porphyrins in the blood and body tissues. The symptoms of porphyria depend on which enzyme is deficient.

Long-term side effects or complications of porphyria include problems with the nervous system and mental health conditions. A person suffering from porphyria can develop psychiatric disorders or problems such as paranoia, anxiety, and depression, among others. Apart from this, problems such as depression, restlessness, hallucinations, extreme sensitivity to light, and muscle weakness can also be caused by porphyria. In certain cases, porphyria can trigger other conditions, such as seizures.

When the deficiency is in heme synthesis, the nervous system and liver are mainly affected. Also, the skin of the patient (or sufferer) becomes highly sensitive to sunlight, and there may be stomach pain and nausea.When the deficiency is in uroporphyrinogen decarboxylase, the skin may be photosensitive, and there are changes in the amount of urine and stool. Folic acid deficiency in porphyria may result in mental disturbances and abdominal pain. In severe cases, there can even be paralysis and coma.

Home remedies for porphyria

Porphyria is a condition in which the body is unable to properly process hemoglobin, which is a major component of blood. This is a rare, serious, and potentially life-threatening condition that can cause harm to the liver and nervous system.

Due to a lack of proper hemoglobin, it may also cause a lack of vitamin B12. So, if you have symptoms such as blue-red urine, conserving urine, stomach pain, itching and inflammation, or breathing difficulties, try these remedies:

  • Try eating foods that are rich in B-12, such as milk, yogurt, cheese, chicken, and beef
  • You could also try using vitamin B-12 supplements
  • You could also try using fresh fruit juices to relieve the symptoms
  • Try using natural anti-inflammatories such as omega-3 fatty acids (fish and flaxseed are the best sources)
  • You could also try using black walnut, which is a natural remedy that treats porphyria (it helps the body build healthy hemoglobin)

What should I eat while suffering from porphyria?

One thing to note about porphyria is that most cases are chronic, and unfortunately, the exact cause of this condition is yet to be identified. So eating foods that might help in this case is a trial-and-error process unless the porphyria symptoms are triggered by a particular food.

Having said that, one food that has been believed to alleviate some symptoms associated with some porphyria diseases is pumpkin seeds. However, if you are suffering from severe symptoms, you might want to consult your doctor before consuming pumpkin seeds.

What should I not eat while suffering from porphyria?

Porphyria is a rare disorder of the red blood cells. The main symptoms of porphyria are sensitivity to sunlight, abdominal pain, and mental confusion. Since sunlight is the main trigger of this disease, people with porphyria should avoid exposure to sunlight.

They are also recommended to avoid alcohol and products containing salicylates. There are different types of porphyria; therefore, it is important to consult a physician or an expert dietician to get individual recommendations.

Porphyria treatments

There is no cure available for porphyria, but there are fortunately some treatment options that can help. That said, only the symptoms associated with certain porphyria disorders can be managed with some medicines. Moreover, people having severe attacks may need to be rushed and admitted to a hospital.

Most treatments for porphyria are primarily aimed at lowering the level of porphyrins in the system and preventing the accumulation of porphyrins in the body. Treatment should be started right away because the symptoms get progressively worse if not treated at the first sign of porphyria. If a severe case of porphyria is left untreated, it can even lead to the patient's demise.

Which doctor should I consult for porphyria?

If you think you might have porphyria, it's important to see your primary care provider or family doctor first. They will most likely be able to tell you if you need to see a specialist, such as a hematologist, who treats blood disorders. Porphyria can be difficult to diagnose because the symptoms vary and come and go.

Which are the best medicines for porphyria?

Porphyria is an acute or chronic condition caused by a lack of heme pigment in the blood and liver. The acute variety is caused by exposure to sunlight or certain drugs, while the chronic variety has non-acute symptoms and is inherited.

The treatment of acute porphyria consists of covering the skin with clothes, covering the head with a hat, and avoiding being exposed to sunlight. Apart from that, chronic porphyrias may be treated with drugs such as chloroquine and hematin.

Which doctor should I consult for porphyria?

This is a complicated question with no accurate (or single) answer. In fact, it entirely depends on the kind of porphyria a person has and, for that matter, how severe it is. Some people fully recover in a few months, while others can deal with the symptoms for the rest of their lives.

Are the results of the treatment permanent?

The results of a porphyria treatment are usually not permanent, as there is no cure available for this rare condition. However, with the daily use of an iron supplement and other supplements or some medication, the symptoms can be dealt with. As it is a reparative treatment, once the symptoms are arrested, recurrence is possible, but it can be minimized with good maintenance and monitoring.

Who is eligible for the treatment?

Many people just show signs of a porphyria disease that never existed for them. So, you should only go to the doctor if you have had any serious symptoms for more than a couple of months.

The first symptom is abdominal pain, especially on the upper right side. This pain may get worse when you eat. The second symptom is unintentional weight loss. The third symptom is yellowing of the skin, which is not always apparent.

The doctor will also test for porphyria by taking a blood test. If the test turns out to be positive, you may be eligible for the porphyria treatment. So you should first see an expert healthcare professional if you have had these symptoms.

Who is not eligible for the treatment?

Anyone suffering from any kind of porphyria should receive proper treatment, while the others should not. Anybody with a confirmed diagnosis of any acute porphyria (APS, AIP, or HCP) is eligible for treatment. People with variegate type II and erythropoietic protoporphyria (EPP) can usually be treated by their healthcare provider at home or in a hospital.

What are the post-treatment guidelines?

The first goal of treatment is to switch the porphyrin precursors from hepatic to renal excretion. The next goal is to reduce the body's production of porphyrins even further, as well as the excessive excretion of precursors (that is, to increase the amount of precursors left in the body).

To accomplish these goals, some doctors start out with low doses of penicillamine and trientine and then add other drugs (such as zinc, magnesium, or quinolones, such as ciprofloxacin or norfloxacin) to help reduce the production of porphyrins. In some cases, the doctor begins with high doses of the two drugs and then switches to the lower doses.

Having said that, the post-porphyria treatment guidelines have several parameters and differ from individual to individual depending on his or her case. It is important that they be strictly followed by the sufferer (or patient) to avoid further complications.

What is the price of porphyria treatments in India?

Standard porphyria treatment is best carried out in a hospital in India to improve quality of care and ensure patient safety, as well as to ensure affordability. Each treatment in the country can cost around 40,000 to 2,00,000 INR or more, depending on the severity of the disease.

What are the side effects of porphyria treatments?

A patient suffering from porphyria will first undergo a detailed medical examination to diagnose the disease. Treatment generally involves large doses of drugs such as heme arginate, heme succinate, heme chloride, bilirubin, etc. These drugs are used to decrease the amount of porphyrin present in the body.

The most common side effects of these drugs are nausea, anorexia, vomiting, epigastric pain, constipation, abdominal cramps, eye pain, vision loss, skin rashes, itching, hives, dizziness, fatigue, weakness, headaches, hypochromic anemia, and mental confusion. Some serious side effects of these drugs include death and liver damage. Taking food supplements like vitamin B-12, vitamin C, iron, and zinc may help the patient overcome these side effects to some extent.

Porphyria: outlook / prognosis

Porphyria is basically a group of rare metabolic diseases (or disorders) that affect the skin and internal organs, such as the nervous system. If you think that you or a loved one might have porphyria, it's important to see a physician as soon as possible. This is because the symptoms are often mistakenly interpreted as something else, such as a stomach problem or psychological disorder.


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Written ByDr. Vikram Gidwani MBBSSexology
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Reviewed ByDr. Bhupindera Jaswant SinghMD - Consultant PhysicianGeneral Physician
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