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drug-induced photosensitivity
Photosensitivity may be phototoxic reaction or photoallergic reaction
Etiology:
Pharmaceutical agents associated with photosensitivity:
1) Antibiotics
- amoxicillin
- antimalarials (phototoxic)
- fluroquinolones including ciprofloxacin (phototoxic)
- clofazimine
- dapsone
- demeclocycline
- doxycycline (phototoxic)
- enoxacin
- flucytosine
- griseofulvin
- lomefloxacin
- minocycline
- nalidixic acid
- norfloxacin
- ofloxacin
- oxyfloxacin
- oxytetracycline
- pyrazinamide
- sulfonamide (phototoxic)
- tetracycline (phototoxic)
- trimethoprim
- voriconazole (phototoxic)
2) Antidepressive agents
- amitriptyline
- amoxapine
- clomipramine
- desipramine
- doxepin
- fluoxetine
- imipramine
- maprotiline
- nortriptyline
- phenelzine
- protriptyline
- trazodone
- trimipramine
3) Antihistamines
- astemizole
- cimetidine
- cryproheptadine
- diphenhydramine
- ranitidine
- terfenadine
4) Antihypertensive agents
1) beta blockers
2) captopril
3) diltiazem
4) methyldopa
5) minoxidil
6) nifedipine
5) Antiparasitic agents
- chloroquine
- quinine
- thiabendazole
6) Antipsychotic agents
- chlorpromazine
- fluphenazine
- haloperidol
- perphenazine
- prochlorperazine
- thioridazine
- thiothixene
- trifluoperazine
- triflupromazine
7) Cancer chemotherapy agents
- dacarbazine (DTIC)
- fluorouracil
- flutamide
- methotrexate
- vinblastine
8) Dermatologic agents*
- oral & topical retinoids
- all-trans retinoic acid or tretinoin (Retin-A)
- 13-cis-retinoic acid or isotretinoin (Accutane)
- 5-fluorouracil (Effudex)
- coal tar
- psoralens
9) Diuretics
- acetazolamide
- amiloride
- bendroflumethiazide
- benzthiazide
- chlorthiazide
- furosemide
- hydrochlorothiazide (HCTZ)
- hydroflumethiazide
- methyclothiazide
- metolazone
- polythiazide
- triamterene
- trichlomethiazide
10) Hypoglycemic agents
- acetohexamide
- chlorpropamide
- glipizide
- glyburide
- tolazamide
- tolbutamide
11) Non-steroidal anti-inflammatory agents
- benoxaprofen
- diclofenac
- diflusinal
- fenbufen
- ibuprofen
- indomethacin
- ketoprofen
- nabumetone
- naproxen
- phenylbutazone
- piroxicam
- sulindac
12) Sunscreens
- aminobenzoic acid
- avobenzone
- benzophenones
- cinnamates
- homosalate
- methyl anthranilate
- para-aminobenzoic acid (PABA)
13) Miscellaneous pharmaceuticals
- alprazolam
- amantadine
- amiodarone (phototoxic)
- benzocaine
- benzoyl peroxide
- bermagot oils
- oils of citron
- lavender
- lime
- sandalwood
- cedar
- carbamazepine
- chlordiazepoxide
- clofibrate contraceptives, oral
- desoximetasone
- disopyramide
- etretinate
- fluorescein
- gold salts
- griseofulvin
- hexachlorophene
- isotretinoin
- 6-methylcoumarin
- musk ambrette
- promethazine
- trimeprazine
* major culprits [3]
Pathology:
1) phototoxic eruption
a) acute inflammation of the skin resembling sunburn
b) drug distributes into skin & absorbs UV radiation
c) direct photochemical reaction then results in tissue injury
2) photoallergic reaction
a) drug distributes into skin
b) produces delayed hypersensitivity reaction after exposure to sunlight
Management:
1) treatment similar to acute sunburn & allergic-contact dermatitis
2) supportive care
3) topical glucocorticoids
4) sunscreen (UV-A & UV-B)
5) protective clothing
6) discontinue photosensitizing agents
Related
contact dermatitis (exogenous eczema)
sunburn
Specific
photoallergic drug reaction
General
photosensitivity
References
- Color Atlas & Synopsis of Clinical Dermatology, Common
& Serious Diseases, 3rd ed, Fitzpatrick et al, McGraw Hill, NY,
1997, pg 985
- Medical Knowledge Self Assessment Program (MKSAP) 11, American
College of Physicians, Philadelphia 1998
- Drug-Induced Photosensitivity
Prescriber's Letter 11(5):27 2004
Detail-Document#: 200509
(subscription needed) http://www.prescribersletter.com
- Prescriber's Letter 16(6): 2009
Drugs that Increase Photosensitivity
CHART: Drugs that Increase Photosensitivity
COMMENTARY: Sunscreens: Achieving Optimal Protection
Detail-Document#: 250606
(subscription needed) http://www.prescribersletter.com
- Moore DE
Drug-induced cutaneous photosensitivity: incidence,
mechanism, prevention and management.
Drug Saf 2002;25:345-72
PMID: 12020173
- Allen JE
Drug-induced photosensitivity
Clin Pharm 1993;12:580-7.
PMID: 8222522
- Prescriber's Letter 22(8): 2015 (subscription needed)
CHART: Drug-Induced Photosensitivity
PATIENT EDUCATION HANDOUT: Staying Safe in the Sun
PATIENT EDUCATION HANDOUT SPANISH VERSION: Seguridad del sol
Detail-Document#: 310807
http://www.prescribersletter.com
- Monteiro AF, Rato M, Martins C.
Drug-induced photosensitivity: photoallergic and phototoxic reactions.
Clin Dermatol. 2016;34:571-81.
PMID: 27638435