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Major Features of the Two Most Common Hepatic Porphyrias

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Porphyria	Presenting Symptoms	Exacerbating Factors	Most Important Screening Tests*	Treatment
Acute intermittent porphyria	Neurovisceral (intermittent, acute)	Alcohol ingestion Fasting/crash dieting Gastric sleeve or bypass surgery Infections Medications (mostly cytochrome P-450 inducers) Organic solvents Physical or emotional stress/intercurrent illness Progesterone/progestogens	Urinary PBG and creatinine†	Glucose Heme GivosiranGivosiran
Porphyria cutanea tarda	Blistering skin lesions (chronic)	Alcohol ingestion Estrogens Halogenated hydrocarbons Hepatitis C virus HIV Iron Smoking	Urinary or plasma porphyrins	Direct-acting antivirals to cure hepatitis C virus infection Low-dose chloroquine or hydroxychloroquineLow-dose chloroquine or hydroxychloroquine Phlebotomy
* In symptomatic phase.
† Creatinine is obtained to normalize urinary PBG levels since urinary dilution varies.
PBG = porphobilinogen.