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Lindemann H, Diehl-Wiesenecker E, Gerischer L, Frank J. [An overview of porphyrias]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:539-547. [PMID: 38902527 DOI: 10.1007/s00105-024-05370-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/17/2024] [Indexed: 06/22/2024]
Abstract
Porphyrias are predominantly genetic metabolic disorders caused by dysregulation of specific enzymes in porphyrin-heme biosynthesis. The enzymatic dysfunction leads to formation and excretion of intermediate metabolic products in the form of porphyrins and/or their precursors δ‑aminolevulinic acid and porphobilinogen, which have cyto- and tissue-toxic properties. Clinically, porphyrias are extremely diverse, with symptoms ranging from skin changes on light-exposed areas of the body to potentially life-threatening neurovisceral attacks. Biochemical tests in urine, blood and stool are used for diagnosis, which can be supplemented by molecular genetic analyses. Treatment of the various forms of porphyria is complex and often requires close interdisciplinary cooperation between different medical specialties.
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Affiliation(s)
- Hanna Lindemann
- Klinik für Dermatologie und Allergologie, Universitätsspital Basel, Basel, Schweiz
| | - Eva Diehl-Wiesenecker
- Innere Medizin mit Gastroenterologie und Nephrologie, Zentrale Notaufnahme, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Lea Gerischer
- Klinik für Neurologie mit Experimenteller Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Jorge Frank
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen, Robert Koch Str. 40, 37075, Göttingen, Deutschland.
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Muschalek W, Hermasch MA, Poblete-Gutiérrez P, Frank J. The Porphyrias. J Dtsch Dermatol Ges 2022; 20:316-331. [PMID: 35304965 DOI: 10.1111/ddg.14743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 01/16/2022] [Indexed: 12/01/2022]
Abstract
The porphyrias are clinically variable and genetically heterogeneous, predominantly hereditary metabolic diseases, which are caused by a dysfunction of specific enzymes in heme biosynthesis. Here, we provide an overview of the etiopathogenesis, clinic, differential diagnosis, laboratory diagnostics and therapy of these complex metabolic disorders and cover in detail the most common form of porphyria worldwide (porphyria cutanea tarda), the most frequent childhood porphyria (erythropoietic protoporphyria), and the most common neurocutaneous porphyria (variegate porphyria).
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Affiliation(s)
- Wiebke Muschalek
- Department of Dermatology, Venereology and Allergology, University Hospital Göttingen, Göttingen, Germany
| | - Matthias A Hermasch
- Department of Dermatology, Venereology and Allergology, University Hospital Göttingen, Göttingen, Germany
| | | | - Jorge Frank
- Department of Dermatology, Venereology and Allergology, University Hospital Göttingen, Göttingen, Germany
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Muschalek W, Hermasch MA, Poblete-Gutiérrez P, Frank J. Die Porphyrien. J Dtsch Dermatol Ges 2022; 20:316-333. [PMID: 35304948 DOI: 10.1111/ddg.14743_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 01/16/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Wiebke Muschalek
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Matthias A Hermasch
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | | | - Jorge Frank
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
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Kaftory R, Edel Y, Snast I, Lapidoth M, Mamet R, Elis A, Hodak E, Levi A. Greater disease burden of variegate porphyria than hereditary coproporphyria: An Israeli nationwide study of neurocutaneous porphyrias. Mol Genet Metab Rep 2021; 26:100707. [PMID: 33489763 PMCID: PMC7811049 DOI: 10.1016/j.ymgmr.2021.100707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 12/31/2020] [Indexed: 11/02/2022] Open
Abstract
Hereditary coproporphyria (HCP) and variegate porphyria (VP) are referred to as neurocutaneous porphyrias (NCP). Data concerning their systemic presentation are limited and no direct attempt of comparison of the two has ever been made. Our aim was to describe the type and frequency of systemic manifestations of NCPs in Israeli patients. A cross-sectional survey was conducted. The study population included all patients with NCP diagnosed at the Israeli National Service for Biochemical Diagnoses of Porphyrias (INSP) between 1988 and 2019. Of the 83 patients with NCP who were alive in 2019, 61 (73%) completed the survey, 40 with VP and 21 with HCP. Systemic symptoms were reported by 63% of the VP group and 62% of the HCP group (p = .96); corresponding rates of cutaneous symptoms were 58% and 5% (p < .001). We found no association between the occurrence of systemic and cutaneous symptoms. Among patients with systemic involvement, abdominal pain was the predominant systemic symptom, found in 64% of the VP group and 69% of the HCP group; Analysis of symptom frequency showed that in 68% of the VP group, systemic symptoms (either abdominal, musculoskeletal or neuropsychiatric) occurred on a daily/weekly basis, whereas the HCP group experienced less than one symptom per week (p < .001). This nationwide study depicts a significantly heavier disease burden in VP patients compared to HCP owing to its more frequent neurovisceral and cutaneous manifestations.
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Affiliation(s)
- Ran Kaftory
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Yonatan Edel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- National Service for the Biochemical Diagnoses of Porphyrias, Rabin Medical Center – Beilinson Hospital, Petah Tikva 4941492, Israel
- Department of Internal Medicine C, Rabin Medical Center – Beilinson Hospital, Petah Tikva 4941492, Israel
| | - Igor Snast
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Photodermatosis Service, Division of Dermatology, Rabin Medical Center, Petah Tikva 4941492, Israel
| | - Moshe Lapidoth
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Photodermatosis Service, Division of Dermatology, Rabin Medical Center, Petah Tikva 4941492, Israel
| | - Rivka Mamet
- National Service for the Biochemical Diagnoses of Porphyrias, Rabin Medical Center – Beilinson Hospital, Petah Tikva 4941492, Israel
| | - Avishay Elis
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Internal Medicine C, Rabin Medical Center – Beilinson Hospital, Petah Tikva 4941492, Israel
| | - Emmilia Hodak
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Photodermatosis Service, Division of Dermatology, Rabin Medical Center, Petah Tikva 4941492, Israel
| | - Assi Levi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Photodermatosis Service, Division of Dermatology, Rabin Medical Center, Petah Tikva 4941492, Israel
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Albert AA, Frank J. [58-year-old male with blistering on the back of the hands and dark urine : Preparation for the specialist examination: Part 37]. Hautarzt 2019; 70:41-44. [PMID: 30976858 DOI: 10.1007/s00105-018-4344-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Annika A Albert
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - Jorge Frank
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
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