Drug-Induced Photosensitivity

Abstract

Photo-induced drug eruptions are cutaneous adverse events due to exposure to a drug and either ultraviolet or visible radiation. Based on their pathogenesis, they can be classified as phototoxic or photoallergic drug eruptions, although in many cases it is not possible to determine whether a particular eruption is due to a phototoxic or photoallergic mechanism. In this review, the diagnosis, prevention and management of drug-induced photosensitivity are discussed. Diagnosis is based primarily on the history of drug intake and the clinical appearance of the eruption, primarily affecting sun-exposed areas of the skin. Phototesting and photopatch testing can be useful adjuncts in making a diagnosis. The mainstay of management is prevention, including informing patients of the possibility of increased sun sensitivity and the use of sun protective measures. However, once the eruption has occurred, it may be necessary to discontinue the culprit medication and treat the eruption with a potent topical corticosteroid. Drugs that have been implicated in causing photosensitive eruptions are reviewed. Tetracycline, doxycycline, nalidixic acid, voriconazole, amiodarone, hydrochlorothiazide, naproxen, piroxicam, chlorpromazine and thioridazine are among the most commonly implicated medications. We review the medical literature regarding evidence for the culpability of each drug, including the results of phototesting, photopatch testing and rechallenge testing.

Generation of reactive aryl radical intermediates in the reductive photodehalogenation of itraconazole

“…[31][32][33][34] Thus, the attention was focused on the ability of radical 1 c to react with proteins, and in particular with the aromatic amino acid residues, for instance the indole heterocycle of tryptophan (Trp). With this aim, a model dyad (5) was designed by linking Trp methyl ester with 2,4-dichlorophenylacetic acid, which contains the reactive moiety of 1 (Fig. 5).…”

“…2,3 Among the adverse effects of antifungal triazole drugs, some medical cases of photosensitivity as skin responses upon exposure to sunlight have been reported. [4][5][6][7] In the case of 1, they correspond to erythema, oedema and vesicles on sun-exposed areas as described aer ve days of treatment for oral candidiasis. 4 Photosensitizing effects of drugs are of increasing concern in modern lifestyle.…”

Dapsone induced photosensitivity in Indian women: a rare case

“…11 Drugs implicated in causing photosensitive eruptions are sulphonamides, tetracycline, doxycycline, chloroquin, nalidixic acid, fluoroquinolones, griseofulvin, voriconazole, amiodarone, hydrochlorothiazide, naproxen, piroxicam, amisulpride, chlorpromazine and thioridazine. 12,13 Both topical and systemic sulphonamides are known sensitisers for photoallergic reactions. The characteristic sulphone group (C-SO2-C) as well as its metabolites are perpetrators.…”

Idiopathic pulmonary fibrosis: a holistic approach to disease management in the antifibrotic age

“…Pirfenidone may cause a skin rash or photosensitivity. Preventative advice should be given, including avoiding direct sun exposure, wearing protective clothing and applying UVA and UVB sunscreen factor 50 (28). A mild to moderate photosensitive reaction requires dose reduction for 7 days with recommencement of treatment if resolving.…”