The acute attack of porphyria

It has long been recognized that patients with certain types of porphyria are subject to bizarre neurologic episodes or “acute attacks.” This syndrome has captured the imagination of both clinicians and edical historians, the latter debating earnestly and regularly whether porphyria was the cause of George III of Britain's “madness” or Mary, Queen of Scots' abdominal pain and how this may have affected the course of history.¹ For individuals affected by either acute intermittent porphyria (AIP), variegate porphyria (VP) or hereditary coproporphyria (HC), the episode is, however, of far greater practical than of philosophical import as it represents perhaps the major determinant of their morbidity and mortality. It was therefore thought pertinent to include a chapter on this syndrome in the text, although it is aimed at those medical practitioners whose interest in the porphyrias is primarily dermatologie.