Doxycycline-Associated Dual Cutaneous Adverse Reaction to the Drug (CARD): Case Report of Concurrent Photosensitivity and Morbilliform Exanthem to Doxycycline

Jacob, Joanne S; Cohen, Philip R.

doi:10.7759/cureus.11546

Cited by 4 publications

(3 citation statements)

References 18 publications

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“…These can be systemic such as such headaches, pseudotumor cerebri, and hand tremors. Cutaneous adverse events associated with doxycycline have also been described, including morbilliform exanthem, photosensitivity, and rarely, skin and nail hyperpigmentation [ 7 - 18 ].…”

Section: Discussionmentioning

confidence: 99%

Doxycycline-Associated Hyperpigmentation: A Case Report and Literature Review

Afrin¹,

Cohen²

2022

Cureus

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Drug-induced hyperpigmentation is an adverse cutaneous effect; it has been associated with several systemic medications. A healthy 40-year-old man developed facial and dorsal hand hyperpigmentation within two weeks of beginning doxycycline monohydrate 100 milligrams twice daily for acne. Skin pigmentation significantly diminished at a follow-up evaluation two months after discontinuing the medication. Doxycycline-associated skin hyperpigmentation, albeit uncommon, has been described in 18 patients in the literature, including our patient. The demographics included 13 males and five females ranging in age from 11 to 87 years; eight of the patients were less than 50 years old and ten of the patients were over 60 years old. Doxycycline-associated hyperpigmentation frequently occurs on the face and can occur at the site of a previous scar. In most cases, doxycycline was discontinued with the resolution of hyperpigmentation.

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Section: Discussionmentioning

confidence: 99%

Doxycycline-Associated Hyperpigmentation: A Case Report and Literature Review

Afrin¹,

Cohen²

2022

Cureus

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“…Moreover, systemic antibiotics might exert more adverse effects. For instance, oral doxycycline and tetracycline may result in side effects such as gastrointestinal discomfort, photosensitivity, morbilliform exanthem, and other discomforts ( Smilack, 1999 ; Jacob and Cohen, 2020 ). It is important to balance the treatment efficacy and side effects when making the decision among the varieties of antibiotics based on the phenotype.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of antibiotic agents in the treatment of rosacea: a systemic network meta-analysis

et al. 2023

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Background: Antibiotics are considered the backbone of rosacea management, especially for controlling inflammatory papules and pustules. We aim to evaluate the efficacy and safety of varied prescriptions and doses of antibiotics in treating rosacea by network meta-analysis.Methods: In this study, we compared all available randomized controlled trials (RCTs) that have studied systemic and topical antibiotics and placebo in rosacea therapy. We searched databases such as the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PubMed, Web of Science, and LILACS for published and unpublished RCTs on ClinicalTrials.gov before April 2023. The primary outcome was the improvement of the Investigator's Global Assessment (IGA) scores, and the secondary outcomes consisted of the improvement of the Patient's Global Assessment (PaGA) scores, Clinician's Erythema Assessment (CEA) scores, and adverse events (AEs). We used Bayesian random effects models for multiple treatment comparisons.Results: We identified 1,703 results through these databases. Thirty-one randomized trials with 8,226 patients were included. The heterogeneity and inconsistency between the trials were low, with a low risk of bias of all trials. Oral doxycycline 40 mg, minocycline 100 mg, and minocycline 40 mg, as well as topical ivermectin and metronidazole 0.75%, were effective in treating papules and pustules, thereby decreasing IGA in rosacea. Among these, minocycline 100 mg ranked top in efficacy. As for improving the PaGA scores, topical ivermectin, metronidazole 1%, and systemic oxytetracycline were effective, of which oxytetracycline worked the best. Both doxycycline 40 mg and metronidazole 0.75% presented no therapeutic effect for erythema. Considering the safety of the agents, systemic application of azithromycin and doxycycline 100 mg significantly increase the risk of AEs.Conclusion: Our review suggests that a high dosage of systemic minocycline is the most effective in treating rosacea phenotypes with papules and pustules with a low risk of AEs. However, there were no sufficient evidence-based data in exploring the influence of antibiotics on erythema. The phenotype of rosacea should be taken into consideration along with benefit and safety when making prescriptions due to AEs.Clinical Trial Registration: NCT(2016): http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/962/CN-01506962/frame.html NCT(2017): http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/764/CN-01565764/frame.html

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“…Photoallergic reactions are uncommon, require prior exposure to the drug, can occur with low doses of the drug, typically do not manifest after the initial exposure, develop one to three days after initiation of the drug, present with morphology similar to dermatitis, originate on sun-exposed sites, and subsequently evolve to potentially include the entire body with the appearance of eczematous dermatitis. In contrast, phototoxic reactions are more common, do not require prior exposure to the medication, increase in frequency with higher doses of the drug, may occur after the initial treatment, often begin within minutes to hours after receiving the drug, present with erythematous and edematous lesions, and may even include blisters that morphologically mimic an acute sunburn whose distribution is restricted to areas exposed to the sun [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Sofosbuvir-Velpatasvir (Epclusa)-Associated Photosensitivity in a Hepatitis C Patient: Case Report and Review of Photosensitivity to Hepatitis C Antiviral Agents

Glombicki¹,

Cohen²

2021

Cureus

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Hepatitis C is a ribonucleic acid (RNA) virus, and its presence in individuals was previously considered to be a chronic condition. However, recent therapeutic advances with virus-directed treatment have resulted in a significant increase in cure rates as demonstrated by an absence of virus on repeat testing. Currently, several individual and combination antiviral therapies are available for the treatment of hepatitis C virus infection. However, each of the hepatitis C antiviral agents is associated with potential adverse skin effects whose incidence varies depending on the agent used for treatment. The cutaneous reactions, including photosensitivity, usually resolve once the antiviral treatment is completed. In this report, we discuss the case of a chronic hepatitis C patient who developed sofosbuvir-velpatasvir (Epclusa)-associated toxicity, while receiving the antiviral therapy. The 57-year-old man developed cutaneous phototoxicity when he started treatment with the drug. The adverse skin reaction promptly resolved once the treatment was completed. Clinicians who manage patients being treated with antiviral agents for hepatitis C infection should consider counseling these individuals regarding photoprotection including avoidance of sun exposure, daily sunscreen use, and wearing photoprotective clothing.

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Doxycycline-Associated Dual Cutaneous Adverse Reaction to the Drug (CARD): Case Report of Concurrent Photosensitivity and Morbilliform Exanthem to Doxycycline

Cited by 4 publications

References 18 publications

Doxycycline-Associated Hyperpigmentation: A Case Report and Literature Review

Doxycycline-Associated Hyperpigmentation: A Case Report and Literature Review

Efficacy and safety of antibiotic agents in the treatment of rosacea: a systemic network meta-analysis

Sofosbuvir-Velpatasvir (Epclusa)-Associated Photosensitivity in a Hepatitis C Patient: Case Report and Review of Photosensitivity to Hepatitis C Antiviral Agents

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