# Porphyria - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class TD99.07 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Porphyria Cutanea Tarda - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK563209/ · Zinc oxide sunscreen US OTC label, Directions (DailyMed SetID 005d0245-fe53-47e5-888b-683f58cd6d26) - Verified date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care - Porphyria - disease-level clinical article (porphyria-clinical.txt) ## Treatment metadata - No drug therapy in primary care (Referral & Advice) - Zinc oxide — topical ## Complete treatment card ```text PORPHYRIA Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class TD99.07 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Porphyria Cutanea Tarda - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK563209/ · Zinc oxide sunscreen US OTC label, Directions (DailyMed SetID 005d0245-fe53-47e5-888b-683f58cd6d26) Review status: REVIEWED against No dose - referral pathway, no medicine given in primary care, Porphyria - disease-level clinical article (porphyria-clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (3) - Urine may turn reddish-brown from porphyrin buildup, so urine color should be asked about specifically. - Because the photosensitivity is delayed, most patients do not connect their blisters with sun exposure. - Excess facial hair growth is common, and thickening at the cornea's edge occurs less often. SIGNS - what you find (3) - Repeated blistering leaves behind patchy scarring, pigment change, and small keratin-filled papules called milia. [papules · scarring] - Scarring can contract the skin enough to mimic scleroderma, a phenomenon termed pseudoscleroderma. [scarring] - In women, hair growth on the cheeks, temples, and forearms may be the only physical sign present. TESTS (5) - Urine shows raised uroporphyrin and heptacarboxyl porphyrin, with normal ALA and porphobilinogen levels. - Markedly high red-cell protoporphyrin separates hepatoerythropoietic porphyria from PCT. - Neutral-pH plasma fluorescence peak wavelength is one way to tell PCT apart from variegate porphyria. - Stool porphyrins, including uroporphyrin, isocoproporphyrin, and protoporphyrin, are raised while red-cell porphyrin levels stay normal. - Skin biopsy, when done, can show subepidermal blistering with porphyrin deposits in vessel walls. IF NOT THIS - what else fits (7) - Variegate porphyria shows raised urinary coproporphyrins, ALA, and porphobilinogen, unlike PCT. - Congenital erythropoietic porphyria also has normal urinary ALA and porphobilinogen levels. - Neurovisceral symptoms are present in variegate porphyria and hereditary coproporphyria but are absent in PCT. - Pseudoporphyria looks identical to PCT clinically and on biopsy but has normal porphyrin levels, and is linked to drugs like NSAIDs, furosemide, or retinoids. - Epidermolysis bullosa acquisita causes widespread blistering that is not confined to sun- exposed skin, unlike PCT. - Polymorphic light eruption is an itchy sun-triggered rash appearing within hours of exposure that heals without scarring. - Bullous lupus causes widespread blisters that heal without scarring or milia, with a neutrophil-rich infiltrate on biopsy. Source StatPearls "Porphyria Cutanea Tarda" - disease-level clinical article Status traced to the source above Rx: Main treatment | Mineral sunblock - the only kind that covers the 400 to 410 nm band MAIN TREATMENT 1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE) [1st line] Adult A rare inherited metabolic disease; the GP's role is to recognise characteristic attacks (abdominal pain, neuropsychiatric symptoms, photosensitive skin lesions) and refer for specialist diagnosis and management, including avoiding drugs known to trigger attacks. - Refer, with advice Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why A rare inherited metabolic disease; the GP's role is to recognise characteristic attacks (abdominal pain, neuropsychiatric symptoms, photosensitive skin lesions) and refer for specialist diagnosis and management, including avoiding drugs known to trigger attacks. Caution An acute porphyric attack with severe abdominal pain, seizures, or neuropsychiatric change is a medical emergency; certain common drugs can precipitate attacks and must be avoided. Rare in Egyptian primary care. No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to. RED FLAG - PCT independently increases the risk for liver cirrhosis and hepatocellular carcinoma, accentuated by coexisting HCV infection, alcoholic hepatitis, or iron overload. RED FLAG - Neurovisceral symptoms (abdominal pain, neuropsychiatric symptoms) distinguish acute porphyrias (variegate porphyria, hereditary coproporphyria) from PCT, where neurovisceral symptoms are absent. MINERAL SUNBLOCK - THE ONLY KIND THAT COVERS THE 400 TO 410 NM BAND - give alongside 2. ZINC OXIDE [add-on - not a substitute] Adult Apply a mineral sunscreen liberally to exposed skin 15 minutes before going out, and again at least every 2 hours - Every day the patient goes out in daylight, for as long as the skin disease is active Peds Ask a doctor before using sunscreen on a child under 6 months. Older children with a photosensitive porphyria use the same mineral products, applied the same way. Source Zinc oxide sunscreen US OTC label, Directions (DailyMed SetID 005d0245-fe53-47e5-888b-683f58cd6d26) - verbatim: "Apply liberally 15 minutes before sun exposure and as needed. Children under 6 months of age: ask a doctor. Reapply at least every 2 hours" Why Porphyria cutanea tarda blisters in visible violet light at 400 to 410 nm, which ordinary chemical sunscreens do not filter - only a zinc oxide or titanium dioxide mineral block does. In Cairo sunshine this is the single most useful thing a GP can hand the patient while the specialist referral is arranged. Caution Check the ingredient list - a sunscreen whose only filters are avobenzone, oxybenzone or octocrylene will not protect this patient; the label must name zinc oxide or titanium dioxide. Sunscreen alone is not enough: long sleeves, a hat and staying out of the sun between 10 a.m. and 2 p.m. matter as much. This is protective, not curative - phlebotomy or hydroxychloroquine is decided by the service the patient is referred to, and alcohol, smoking, oestrogen and iron still have to be avoided. Egypt NAPI-CARE OINT. ARAB DRUG COM... 2.35 EGP PENTADIAPER 20% TOPICAL CREAM 30 GM EVA PHARMA > PENTA PHARMA 3.50 EGP BABY RASH FREE 30% OINT. ALEXANDRIA > ... 5.00 EGP EVA BABY CARE CREAM 50 GM EVA PHARMA 9.75 EGP BALMIX 10% CREAM 30 GM SIGMA 14.40 EGP NONOPENT CREAM 75 GM > PENTA PHARMA 100.00 EGP NINO SERENO CREAM EL NILE > GMCKS 120.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)