Antimicrobial Photosensitive Reactions

Abstract

Photosensitivity reactions are recognized as unwanted adverse effects of an array of commonly administered topical or systemic medications, including nonsteroidal antiinflammatory agents, antifungals, and antimicrobials. When a drug induces photosensitivity, exogenous molecules in the skin absorb normally harmless doses of visible and UV light, leading to an acute inflammatory response. In phototoxic reactions, the damage to tissues is direct; in photoallergic reactions, it is immunologically mediated. In vitro and in vivo assay systems can assist in predicting or confirming drug photosensitivity. The incidence of photosensitivity reactions may be too low to be detected in clinical studies and may become recognized only in the postmarketing stage of drug development. Some drugs have been withdrawn because of photosensitivity effects that appeared after general release. Photosensitivity reactions have been studied for a number of topical antimicrobials and for the sulfonamides, griseofulvin, the tetracyclines, and the quinolones. Incidence and intensity of drug phototoxicity can vary widely among the different compounds of a given class of antimicrobials. When phototoxic effects are relatively low in incidence, mild, reversible, and clinically manageable, the benefits of an antimicrobial drug may well outweigh the potential for adverse photosensitivity effects.

Phototoxic and Photoallergic Reactions

“…This can be reduced with drug intake by the end of the day, to reduce drug concentrations in the circulation and in the skin during the midday. Photoallergy has also been reported with lome floxacin [20,21] and enoxacin [51], sometimes with cross-reaction to other fluorquinolones (ciprofloxacin and flerofloxacin) [84,85]. Experimental …”

“…Hyperpigmentation, or more precisely dyschromia, may occur from the accumulation of the drug or drug metabolites in the dermis, namely from amiodarone, minocycline, and phenothiazines [50,51]. Apart from acute photosensitivity reaction that occurs more frequently, a smaller percentage of these patients, mainly those with lower phototypes, develop a golden-brown, slate gray, or bluish color on sun-exposed areas.…”

“…Systemic tetracyclines, particularly doxycycline and minocycline, are highly phototoxic and induce photoonycholysis and pseudoporphyria and, the latter can also induce a bluish persistent pigmentation [51,52] (Fig. 18.4).…”

“…The fluorquinolones induce phototoxic reactions, in some cases presenting as pseudoporphyria [40], as initially described for the first quinolone antibiotic, nalidixic acid [51], or as purpura in a case by ciprofloxacin [53]. Phototoxicity is particularly important and frequent (4-15% of treated patients) with fleroxacin, lomefloxacin, sparfloxacin, and pefloxacin and less frequent with ciprofloxacin, norfloxacin, ofloxacin, and enoxacin [14].…”

İsotretinoin Tedavisi Alan Hastalarda Darbant UVB İçin Minimal Eritem Dozunun Değerlendirilmesi

“…Reaksiyon için alerjen maddenin minimal konsantrasyonu yeterli olup, genellikle takip eden maruziyetler sonrasında reaksiyon gelişir 1,4 . Fototoksik reaksiyondan farklı olarak döküntü güneş görmeyen deri bölgelerine de yayılabilir 1,3,5,9 . Fotosensitivitenin değerlendirilmesinde en sık fototest kullanılmaktadır 1,3,5 .…”