Dawaa Reference

Clinical reference

Porphyria

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources4 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 against2 documents
  • No dose - referral pathway, no medicine given in primary care
  • Porphyria - disease-level clinical article (porphyria-clinical.txt)

Verified date2026-08

Presentation reference

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.

SourceStatPearls "Porphyria Cutanea Tarda" - disease-level clinical article

Presentation findings are 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 dose and duration

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

Paediatric dose

Children follow the same pathway: recognise and refer. No primary-care medicine is implied.

Dose 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.

Cautions
  • 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

Mineral sunblock - the only kind that covers the 400 to 410 nm band

add-on - not a substitute

Formtopical

Adult dose and duration

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

Paediatric dose

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.

Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
NAPI-CARE OINT.ARAB DRUG COMPANY (ADCO)2.35 EGP
PENTADIAPER 20% TOPICAL CREAM 30 GMEVA PHARMA > PENTA PHARMA3.50 EGP
BABY RASH FREE 30% OINT.ALEXANDRIA > MILLENIUM PHARMA-EGYPT5.00 EGP
EVA BABY CARE CREAM 50 GMEVA PHARMA9.75 EGP
BALMIX 10% CREAM 30 GMSIGMA14.40 EGP
NONOPENT CREAM 75 GM> PENTA PHARMA100.00 EGP
NINO SERENO CREAMEL NILE > GMCKS120.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.