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 (e.g. Fenofibrate)
   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 (Promethazine)
10. 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)
11. Causes: Endocrine Medications - Oral Hypoglycemics
    1. Orinase
    2. Glipizide
    3. Glyburide
12. 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
13. 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
14. 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
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]