Drug-induced Photosensitivity

Aka: Drug-induced Photosensitivity, Photosensitizer, Medication Causes of Phototoxic Reaction, Phytodermatitis, Phytophotodermatitis

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II. Background

  1. Drugs below are Photosensitizers
  2. Skin reactions secondary to Photosensitizers
    1. Hyperpigmentation
    2. Sunburn

III. Signs

  1. Linear or drip pattern of erythema or inflammation
    1. May follow pattern of Photosensitizer contact with skin (e.g. lime or lemon)
  2. Sunburn in well demarcated area (contact with Photosensitizer)
    1. Early
      1. Erythema
      2. Edema
      3. Pain and tenderness
    2. Next
      1. Blistering or bullae
    3. Next
      1. Hyperpigmentation

IV. Management

  1. General measures
    1. Eliminate causative Photosensitizer or lower dose (most reactions are dose dependent)
    2. Use Sunscreen (see below)
    3. Use cool compresses for comfort
    4. Expect Photosensitivity Reactions to persist for weeks
  2. Significant inflammation (red, Blistered) management
    1. Antihistamines (e.g. Cetirizine) as needed for Pruritus
    2. Topical Corticosteroid
      1. Low potency on the face (e.g. Desonide)
      2. Moderate potency on other areas (e.g. Triamcinolone cream)
      3. High potency agents may be considered on hands (e.g. Clobetasol)
    3. Oral Corticosteroids
      1. May be considered in diffuse reaction

V. Prevention

  1. Wear protective clothing
  2. Consider taking photosensitizing medications in the evening (lower drug levels during daytime hours)
  3. UVA exposure is associated with photosensitivity
    1. Use both UVA and UVB protection
    2. Use Zinc Oxide, Titanium Dioxide, Mexoryl for sun block (esp. covers UVA)

VI. Causes: Most Common

  1. Antibiotics (Fluoroquinolones, Tetracyclines, Sulfonamides)
  2. Cardiovascular medications (Amiodarone, Thiazide Diuretics)

VII. Causes: Psychiatric and Neurologic Medications

  1. Tricyclic Antidepressants
    1. Desipramine
    2. Imipramine
  2. Tegretol
  3. Benzodiazepines
  4. Antipsychotic Medications
    1. Thorazine
    2. Compazine
    3. Haldol

VIII. Causes: Cardiovascular Medications

  1. ACE Inhibitors
  2. Calcium Channel Blockers
  3. Methyldopa
  4. Norpace
  5. Amiodarone
  6. Fibric Acid Derivatives (e.g. Fenofibrate)
  7. Diuretics
    1. Furosemide (Lasix)
    2. Hydrochlorothiazide

IX. Causes: Oncology - Antineoplastic medications

  1. Dacarbazine
  2. Fluorouracil
  3. Methotrexate
  4. Vinblastine

X. Causes: Otolaryngology Medications - Antihistamines

  1. Diphenhydramine (Benadryl)
  2. Periactin
  3. Phenergan (Promethazine)

XI. Causes: Infectious Disease Medications

  1. Antibiotics
    1. Fluoroquinolones
    2. Ceftazidime
    3. Trimethoprim
    4. Sulfonamides (e.g. Bactrim)
    5. Tetracycline, Doxycycline and related agents
  2. Antiparasitic Agents
    1. Thiabendazole
    2. Chloroquine
    3. Quinine
  3. Antifungal agents
    1. Griseofulvin
    2. Ketoconazole
    3. Voriconazole (Vfend)

XII. Causes: Endocrine Medications - Oral Hypoglycemics

  1. Orinase
  2. Glipizide
  3. Glyburide

XIII. Causes: Rheumatologic Medications - NSAIDS

  1. Piroxicam (Feldene)
  2. Ibuprofen (Motrin)
  3. Naproxen (Naprosyn) - more common than with Ibuprofen
  4. Nabumetone (Relafen)
  5. Indomethacin (Indocin)
  6. Salicylic acids including Aspirin

XIV. Causes: Dermatologic and Topical Medications

  1. Sunscreens
    1. Benzophenones
    2. Para-aminobenzoic Acid (PABA)
    3. Digalloyl Trioleate
  2. Acne Vulgaris Medications
    1. Isotretinoin (Accutane)
    2. Retin A
    3. Benzoyl Peroxide
    4. Etretinate
  3. Alopecia Medications
    1. Topical Minoxidil
  4. Soap Deodorants
    1. Bithionol
    2. Carbanilide
    3. Dichlorophene
    4. Hexachlorophene

XV. Causes: Phytophotodermatitis - Food, herb, or dye exposure

  1. Oils in Perfumes, Cosmetics, Aftershaves, Lipsticks
    1. Bergamot
    2. Citron
    3. Citrus
    4. Lavender
    5. Lime and other psoralens
    6. Vanillin or Vanilla
    7. Sandalwood
    8. Cedar
    9. 6-Methylcoumarin
    10. Musk ambrette
  2. Pigments and Dyes
    1. Acriflavine
    2. Anthraquinone dye (Disperse blue 35)
    3. Eosin
    4. Neutral red
    5. Proflavine
    6. Rivanol
    7. Yellow cadmium sulfide (used in Tattooing)
    8. Rose bengal
    9. Methylene blue
    10. Fluorescein
  3. Plant exposures
    1. Furocoumarins
    2. Buttercup
    3. Carrots
    4. Celery
    5. Dill
    6. Fennel
    7. Fig
    8. Lime
    9. Mustard
    10. Parsley
    11. Parsnip
    12. St. John's Wort
    13. Yarrow
    14. Psoralens
    15. Ammi majus
    16. Angelica
    17. Coriander
  4. Food additives
    1. Sulfite additives in food

XVI. References

  1. (2023) Presc Lett 30(5): 28-9
  2. (2019) Presc Lett 26(8): 43
  3. Litt (1997) Drug Eruption Reference Manual
  4. Jhun and DeClerck in Herbert (2016) EM:Rap 16(4): 11-2
  5. Drucker (2011) Drug Saf 34(10): 821-37 [PubMed]
  6. Gould (1995) J Am Acad Dermatol 33:551-73 [PubMed]

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