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Drug-induced Photosensitivity
Aka: Drug-induced Photosensitivity, Photosensitizer, Medication Causes of Phototoxic Reaction, Phytodermatitis, Phytophotodermatitis
- Background
- Drugs below are Photosensitizers
- Skin reactions secondary to Photosensitizers
- Hyperpigmentation
- Sunburn
- Signs
- Linear or drip pattern of erythema or inflammation
- May follow pattern of Photosensitizer contact with skin (e.g. lime or lemon)
- Sunburn in well demarcated area (contact with Photosensitizer)
- Early
- Erythema
- Edema
- Pain and tenderness
- Next
- Blistering or bullae
- Next
- Hyperpigmentation
- Management
- General measures
- Eliminate causative Photosensitizer
- Use Sunscreen (see below)
- Use cool compresses for comfort
- Expect Photosensitivity Reactions to persist for weeks
- Significant inflammation (red, Blistered) management
- Topical Corticosteroid
- Low potency on the face (e.g. Desonide)
- Moderate potency on other areas (e.g. Triamcinolone cream)
- High potency agents may be considered on hands (e.g. Clobetasol)
- Oral Corticosteroids
- May be considered in diffuse reaction
- Prevention
- Wear protective clothing
- Consider taking photosensitizing medications in the evening (lower drug levels during daytime hours)
- UVA exposure is associated with photosensitivity
- Use both UVA and UVB protection
- Use Zinc Oxide, Titanium Dioxide, Mexoryl for sun block (esp. covers UVA)
- Causes: Most Common
- Antibiotics (Fluoroquinolones, Tetracyclines, Sulfonamides)
- Cardiovascular medications (Amiodarone, Thiazide Diuretics)
- Causes: Psychiatric and Neurologic Medications
- Tricyclic Antidepressants
- Desipramine
- Imipramine
- Tegretol
- Benzodiazepines
- Antipsychotic Medications
- Thorazine
- Compazine
- Haldol
- Causes: Cardiovascular Medications
- ACE Inhibitors
- Calcium Channel Blockers
- Methyldopa
- Norpace
- Amiodarone
- Fibric Acid derivatives
- Diuretics
- Furosemide (Lasix)
- Hydrochlorothiazide
- Causes: Oncology - Antineoplastic medications
- Dacarbazine
- Fluorouracil
- Methotrexate
- Vinblastine
- Causes: Otolaryngology Medications - Antihistamines
- Diphenhydramine (Benadryl)
- Periactin
- Phenergan
- Causes: Infectious Disease Medications
- Antibiotics
- Fluoroquinolones
- Ceftazidime
- Trimethoprim
- Sulfonamides (e.g. Bactrim)
- Tetracycline (and related agents)
- Antiparasitic Agents
- Thiabendazole
- Chloroquine
- Quinine
- Antifungal agents
- Griseofulvin
- Ketoconazole
- Causes: Phytophotodermatitis - Food, herb, or dye exposure
- Oils in Perfumes, Cosmetics, Aftershaves, Lipsticks
- Bergamot
- Citron
- Citrus
- Lavender
- Lime and other psoralens
- Vanillin or Vanilla
- Sandalwood
- Cedar
- 6-Methylcoumarin
- Musk ambrette
- Pigments and Dyes
- Acriflavine
- Anthraquinone dye (Disperse blue 35)
- Eosin
- Neutral red
- Proflavine
- Rivanol
- Yellow cadmium sulfide (used in Tattooing)
- Rose bengal
- Methylene blue
- Fluorescein
- Plant exposures
- Furocoumarins
- Buttercup
- Carrots
- Celery
- Dill
- Fennel
- Fig
- Lime
- Mustard
- Parsley
- Parsnip
- St. John's Wort
- Yarrow
- Psoralens
- Ammi majus
- Angelica
- Coriander
- Food additives
- Sulfite additives in food
- Causes: Dermatologic and Topical Medications
- Sunscreens
- Benzophenones
- Para-aminobenzoic Acid (PABA)
- Digalloyl Trioleate
- Acne Vulgaris Medications
- Isotretinoin (Accutane)
- Retin A
- Benzoyl Peroxide
- Etretinate
- Alopecia Medications
- Minoxidil
- Soap Deodorants
- Bithionol
- Carbanilide
- Dichlorophene
- Hexachlorophene
- Causes: Endocrine Medications - Oral Hypoglycemics
- Orinase
- Glipizide
- Glyburide
- Causes: Rheumatologic Medications - NSAIDS
- Feldene
- Ibuprofen (Motrin)
- Naproxen (Naprosyn) - more common than with Ibuprofen
- Nabumetone (Relafen)
- Indomethacin (Indocin)
- Salicylic acids including Aspirin
- References
- (2019) Presc Lett 26(8): 43
- Litt (1997) Drug Eruption Reference Manual
- Jhun and DeClerck in Herbert (2016) EM:Rap 16(4): 11-2
- Drucker (2011) Drug Saf 34(10): 821-37 [PubMed]
- Gould (1995) J Am Acad Dermatol 33:551-73 [PubMed]