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Drug-induced Photosensitivity

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

  • Background
  1. Drugs below are Photosensitizers
  2. Skin reactions secondary to Photosensitizers
    1. Hyperpigmentation
    2. Sunburn
  • 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
  • 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
  • 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)
  • Causes
  • Most Common
  1. Antibiotics (Fluoroquinolones, Tetracyclines, Sulfonamides)
  2. Cardiovascular medications (Amiodarone, Thiazide Diuretics)
  • Causes
  • Oncology - Antineoplastic medications
  1. Dacarbazine
  2. Fluorouracil
  3. Methotrexate
  4. Vinblastine
  • 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
  • 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
  • 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
  • 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
  • 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]