Variegate porphyria

A type of porphyria affecting the skin and nervous system

Variegate porphyria
Synonyms	Mixed hepatic porphyria
Pronounce
Field	Dermatology, Medical genetics, Hepatology
Symptoms	Skin photosensitivity, blistering on sun-exposed areas, abdominal pain, neuropathy, seizures, muscle weakness
Complications	Liver damage, kidney disease, neurological deficits, skin infections
Onset	Typically adolescence or adulthood
Duration	Chronic, lifelong condition
Types	Hepatic porphyria
Causes	Mutations in the PPOX gene affecting protoporphyrinogen oxidase
Risks	Family history, certain medications, fasting, hormonal changes, alcohol, smoking, stress
Diagnosis	Urine test, plasma fluorescence scan, genetic testing, porphyrin studies
Differential diagnosis	Acute intermittent porphyria, porphyria cutanea tarda, erythropoietic protoporphyria
Prevention	Avoidance of triggers such as alcohol, sunlight, certain drugs, and fasting
Treatment	Symptomatic treatment, liver transplant in severe cases, avoid triggering factors
Medication	Hemin (for acute attacks), pain relievers, anti-nausea medications
Prognosis	Variable; generally manageable with lifestyle modifications, but attacks can be severe
Frequency	Rare; more prevalent in South African populations due to founder effect
Deaths	Rare, mostly due to complications during acute attacks if untreated

Variegate porphyria has an autosomal dominant pattern of inheritance.

Variegate porphyria (VP) is a type of porphyria, a group of rare metabolic disorders resulting from a deficiency of enzymes in the heme biosynthesis pathway. This condition is characterized by a combination of cutaneous and neurological symptoms due to the accumulation of porphyrins and their precursors.

Pathophysiology

Variegate porphyria is caused by a deficiency of the enzyme protoporphyrinogen oxidase (PPOX), which is the seventh enzyme in the heme biosynthetic pathway. This deficiency leads to the accumulation of porphyrins and their precursors, particularly in the liver, resulting in the clinical manifestations of the disease.

Genetics

Variegate porphyria is inherited in an autosomal dominant pattern, meaning that a single copy of the mutated gene in each cell is sufficient to cause the disorder. The gene responsible for VP is located on chromosome 1 and is known as the PPOX gene. Mutations in this gene reduce the activity of the protoporphyrinogen oxidase enzyme.

Clinical Features

The clinical presentation of variegate porphyria can vary widely among affected individuals. The main features include:

Cutaneous Symptoms

• Photosensitivity: Patients may develop blistering skin lesions on sun-exposed areas.
• Hyperpigmentation and hypopigmentation: Changes in skin color may occur.
• Scarring: Healing of skin lesions can lead to scarring and changes in skin texture.

Neurological Symptoms

• Abdominal pain: Severe, recurrent abdominal pain is a common symptom.
• Peripheral neuropathy: Patients may experience numbness, tingling, or weakness in the limbs.
• Seizures: Some individuals may have seizures as part of the neurological manifestations.
• Psychiatric symptoms: These can include anxiety, depression, and hallucinations.

Diagnosis

The diagnosis of variegate porphyria is based on clinical presentation, family history, and laboratory tests. Key diagnostic tests include:

• Measurement of porphyrins and their precursors in urine, blood, and stool.
• Genetic testing to identify mutations in the PPOX gene.

Management

Management of variegate porphyria involves avoiding triggers, managing symptoms, and preventing complications. Key strategies include:

• Avoidance of sun exposure to prevent cutaneous symptoms.
• Avoidance of drugs and substances known to precipitate attacks, such as certain barbiturates, sulfonamides, and alcohol.
• Use of beta-carotene supplements to reduce photosensitivity.
• Hematin infusions during acute attacks to reduce the production of porphyrin precursors.

Prognosis

The prognosis for individuals with variegate porphyria varies. With appropriate management, many individuals can lead normal lives. However, severe attacks can be life-threatening and require prompt medical attention.

Related pages

• Porphyria
• Heme
• Photosensitivity
• Peripheral neuropathy

External links

• Variegate porphyria at NIH's Office of Rare Diseases

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