• clinical features;
  • erythropoietic protoporphyria;
  • photosensitivity;
  • porphyria;
  • quality of life


Background  Erythropoietic protoporphyria (EPP) is a rare inherited photodermatosis that causes lifelong painful photosensitivity. Neither its full clinical spectrum nor its impact on quality of life (QoL) has been investigated in a large cohort of patients.

Objectives  To document the clinical features of EPP and its impact on QoL in a high proportion of all patients with EPP resident in the U.K.

Methods  Patients with EPP were identified from U.K. clinical databases and assessed by the same clinical investigator over a 7-month period using a standardized proforma and validated adult (Dermatology Life Quality Index, DLQI) and children's (Children's Dermatology Life Quality Index, CDLQI) QoL questionnaires.

Results  Three hundred and eighty-nine living patients with EPP were identified, of whom 223 [114 females, 109 males; median age 34 years (range: 5–87), from 193 families] were investigated. Total erythrocyte porphyrin (TEP) was higher in males (median: 25·3 μmol L−1) than females (median: 19·3 μmol L−1). The median ages at onset and diagnosis were 1 and 12 years, respectively. Median times for onset of symptoms after sun exposure, onset of signs (oedema, erythema) and resolution of symptoms were 20 min, 6 h and 3 days, respectively. Most patients reported absence of protection by glass (92%), priming (85%), exacerbation by wind (68%), no family history of photosensitivity (56%), no symptoms during winter (56%) and had chronic skin lesions (79%). Symptoms changed little with age but improved during pregnancy in 47% of gravid women. Most patients used protective clothing and a sunscreen; 28% were taking β-carotene and a further 56% had taken it; 29% were not under regular medical care. Two patients (1%) had liver failure and 8% reported gallstone disease. QoL was markedly impaired, with scores similar to those in severe dermatological disease (mean DLQI score 14·0, n = 176; mean CDLQI score 12·8, n = 44), indicating a large effect on patients’ lives. DLQI scores correlated weakly with TEP (rs = 0·228; P = 0·002) and time to onset of symptoms (rs = −0·233; P = 0·002) but not with age at onset.

Conclusions  EPP is a persistent, severely painful, socially disabling disease with a marked impact on QoL. Its diagnosis is often overlooked. None of TEP, age at onset nor time to onset of symptoms is a useful predictor of impaired QoL in individual patients.