On a certain day in autumn, your front stoop may be besieged by children dressed as super heroes, vampires or werewolves. This trick or treating tradition dates back to the early 1920’s. The legend of vampires and werewolves, however, are much older: having been mentioned throughout the Middle Ages and possibly even in the Epic of Gilgamesh from around 1800BCE. But what brought about these terrifying tales? Medicine allows for some intriguing hypotheses about how the vampire and werewolf legends arose.  And, interestingly, if you or a loved one has severe sun damage or skin cancer, this information may be pertinent to your health.

A class of disease called “porphyria” (pronounced poor-fear-ee-uh) may be the source of vampire and werewolf legends. Porphyrias are diseases in which someone’s body has problems making “heme,” which is the pigment that makes our blood red. Heme is a complex molecule. It contains an iron atom and a protein called a “porphyrin” (pronounced poor-for-in). Heme holds onto oxygen and allows our blood to take oxygen where it needs to go. 

Porphyrins are made by our bodies in eight steps. Your body starts by making a chemical called ALA (aminolevulinic acid). Then, seven enzymes make changes to ALA to ultimately create heme. Each change creates a different porphyrin. If a single enzyme is defective, then the ALA or porphyrins that the enzyme was supposed to work on start to build up. Similar to the I Love Lucy episode in which Lucille Ball cannot keep up at the chocolate factory, porphyrins start to build up on the assembly line and create a mess.

Depending on which enzyme goes bad, different porphyrins will build up and cause different diseases. For the most part, these excess porphyrins cause disease in two organ systems: the nervous system and the skin. The nervous system can be damaged leading to chronic pain and even seizures. But it is particularly porphyria’s effect on the skin, hair and teeth that may form the origin of a few of folklore’s legendary creatures.

Certain porphyrias can make someone’s skin so sensitive to sun light that the person’s skin is excruciatingly painful as soon as they walk out of the shade. The skin can literally blister after a few minutes in the sun. In some types of porphyria, even small amounts of sun can, over time, lead to thickening and scarring of the skin and thick dark excess hair growth over the affected areas. Even without sun exposure, the teeth can turn red (called “erythrodontia”). Psychosis is sometimes an additional neurologic effect.

Taken together, it is easy to see how conditions that can make the teeth turn red, make someone nocturnal due to pain in sunlight, and occasional excess hair growth and scarring could have led to vampire or werewolf legends. 

Medical literature debates whether these diseases can completely explain the legends. However, legends are often a synthesis of different fears and observations. 

Even if no specific individual had all the signs and symptoms in combination to perfectly mimic a vampire or werewolf, it is certainly plausible that this family of diseases in combination contributed to the development of the vampire and werewolf myths.

While it may not sound appealing to be a vampire for a day, one of modern dermatology’s treatments for precancers called actinic keratoses takes advantage of the porphyrin metabolic pathways to achieve lower rates of skin cancer. Photodynamic therapy (also known as PDT and blue light therapy) works because the physician essentially causes unhealthy cells to develop porphyria for a day. Aminolevulanic acid (the ALA mentioned above) is painted on sun-damaged areas. Unhealthy cells absorb the ALA and become exquisitely sun-sensitive. Healthy cells absorb little medicine. After painting ALA on the skin, the physician exposes the skin to blue light, which activates the ALA in the unhealthy cells causing the unhealthy cells to be hurt and killed. PDT and other therapies such as 5-fluorouracil and imiquimod are important tools in the dermatologist’s armamentarium for combatting pre-cancers and preventing skin cancer.

We hope you enjoyed this excursion into an intriguing realm where science and legend intersect. If you are interested, there is a lot more to read on this topic, simply start Google-ing. And if you or a loved one has skin cancer, pre-cancers, vein problems or other skin care needs, consider making an appointment at Premier Dermatology and Mohs Surgery of Atlanta. Dr. Brent Taylor is a board certified dermatologist and is fellowship-trained in Mohs surgery and varicose vein treatment. 

At Premier Dermatology and Mohs Surgery of Atlanta, it is our pleasure to meet your skin care needs. Board certified and fellowship-trained, Dr. Brent Taylor is a skin cancer, vein and aesthetic expert honored to be of service.

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