Dermatology Book

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Drug-induced Photosensitivity

Aka: Drug-induced Photosensitivity, Photosensitizer, Medication Causes of Phototoxic Reaction, Phytodermatitis, Phytophotodermatitis
  1. Background
    1. Drugs below are Photosensitizers
    2. Skin reactions secondary to Photosensitizers
      1. Hyperpigmentation
      2. Sunburn
  2. 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
  3. Management
    1. General measures
      1. Eliminate causative Photosensitizer
      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. 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)
      2. Oral Corticosteroids
        1. May be considered in diffuse reaction
  4. 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)
  5. Causes: Most Common
    1. Antibiotics (Fluoroquinolones, Tetracyclines, Sulfonamides)
    2. Cardiovascular medications (Amiodarone, Thiazide Diuretics)
  6. 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
  7. Causes: Cardiovascular Medications
    1. ACE Inhibitors
    2. Calcium Channel Blockers
    3. Methyldopa
    4. Norpace
    5. Amiodarone
    6. Fibric Acid derivatives
    7. Diuretics
      1. Furosemide (Lasix)
      2. Hydrochlorothiazide
  8. Causes: Oncology - Antineoplastic medications
    1. Dacarbazine
    2. Fluorouracil
    3. Methotrexate
    4. Vinblastine
  9. Causes: Otolaryngology Medications - Antihistamines
    1. Diphenhydramine (Benadryl)
    2. Periactin
    3. Phenergan
  10. Causes: Infectious Disease Medications
    1. Antibiotics
      1. Fluoroquinolones
      2. Ceftazidime
      3. Trimethoprim
      4. Sulfonamides (e.g. Bactrim)
      5. Tetracycline (and related agents)
    2. Antiparasitic Agents
      1. Thiabendazole
      2. Chloroquine
      3. Quinine
    3. Antifungal agents
      1. Griseofulvin
      2. Ketoconazole
  11. 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
  12. 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. Minoxidil
    4. Soap Deodorants
      1. Bithionol
      2. Carbanilide
      3. Dichlorophene
      4. Hexachlorophene
  13. Causes: Endocrine Medications - Oral Hypoglycemics
    1. Orinase
    2. Glipizide
    3. Glyburide
  14. Causes: Rheumatologic Medications - NSAIDS
    1. Feldene
    2. Ibuprofen (Motrin)
    3. Naproxen (Naprosyn) - more common than with Ibuprofen
    4. Nabumetone (Relafen)
    5. Indomethacin (Indocin)
    6. Salicylic acids including Aspirin
  15. References
    1. (2019) Presc Lett 26(8): 43
    2. Litt (1997) Drug Eruption Reference Manual
    3. Jhun and DeClerck in Herbert (2016) EM:Rap 16(4): 11-2
    4. Drucker (2011) Drug Saf 34(10): 821-37 [PubMed]
    5. Gould (1995) J Am Acad Dermatol 33:551-73 [PubMed]

Meadow grass dermatitis (C0521480)

Concepts Disease or Syndrome (T047)
SnomedCT 95349002, 44483004, 238521005
English Dermatitis bullosa et striata, Phytophotodermatitis due to topical exposure to furocoumarin, dermatitis bullosa striata pratensis (diagnosis), phytophotodermatitis (diagnosis), phytophotodermatitis, dermatitis bullosa striata pratensis, Phytophotodermatitis, Dermatitis bullosa et striata pratensis, Meadow dermatitis, Plant photodermatitis, Dermatitis bullosa striata pratensis, Meadow grass dermatitis, Phytophlyctodermatitis, Phytophotodermatitis (disorder), Phytophotodermatitis due to topical exposure to furocoumarin (disorder), Phytophotodermatitis, NOS
Dutch fytofotodermatitis
French Phytophotodermatose
German Wiesengraeserdermatitis
Italian Fitofotodermatite
Portuguese Fitofotodermatite
Spanish Fitofotodermatosis, dermatitis ampollosa estriada de las praderas, dermatitis de la hierba de las praderas, dermatitis de la pradera, dermatitis de las praderas (trastorno), dermatitis de las praderas, fitoflictodermatitis, fitofotodermatitis (concepto no activo), fitofotodermatitis (trastorno), fitofotodermatitis, fotodermatitis vegetal
Japanese 植物性光線皮膚炎, ショクブツセイコウセンヒフエン
Czech Fytofotodermatitida
Hungarian Phytophotodermatitis
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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