Photopatch testing with an extended series of photoallergens: a 5‐year study

Cardoso, José Carlos; Canelas, Maria Miguel; Gonçalo, Margarida; Figueiredo, Américo

doi:10.1111/j.1600-0536.2009.01550.x

Cited by 61 publications

(58 citation statements)

References 19 publications

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“…According to the results of the photopatch series in Southern European countries, drugs are by far the main cause of exogenous photoallergy, whereas in the Northern countries sunscreens occupy the first rank as photosensitizers [62,[64][65][66]. This may be due to different prescription habits or because NSAIDs, the main drugs responsible for positive photopatch tests, were not regularly included in most photopatch test series.…”

Section: Photosensitive Drugsmentioning

confidence: 96%

“…In most reports, the main topical photosensitizers are the UV filters [3,60,61], which represent 56-80% of the cases diagnosed by photopatch testing [3,[62][63][64]. Furocoumarins from plants are an important source of photosensitivity, mainly in more sunny countries, and drugs are, by far, the most frequent photosensitizers in Southern Europe [62,[64][65][66].…”

Section: Core Messagementioning

confidence: 99%

“…But, happily, concurrent with this high use, adverse skin reactions from UV filters are not reported so frequently [3]. In recent studies, positive photopatch tests or photoaggravated reactions to UV filters occurred in 5.7-12% of a total of about 2,400 patients tested [4,62,[64][65][66][67].…”

Section: Uv Filtersmentioning

confidence: 99%

“…Cinnamates, namely isoamyl-p-methoxycinnamate and ethylhexyl-p-methoxycinnamate, and 4-methylbenzylidene camphor, phenylbenzimidazole sulfonic acid, drometrizole trisiloxane (Mexoryl XL) and octyl dimethyl PABA (Padimate O) are also regularly responsible for cases of photoallergy [3,4,62,64,66,67]. Other UVB filters, namely the salycilates (octylsalycilate and homosalate) and octocrylene are seldom reported to cause allergic or photoallergic contact dermatitis [75,76], except in an Italian study where octocrylene was the most frequent UV filter responsible for photopatch test reactions [66].…”

Section: Uv Filtersmentioning

confidence: 99%

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Phototoxic and Photoallergic Reactions

Gonçalo

2010

Contact Dermatitis

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Section: Photosensitive Drugsmentioning

confidence: 96%

Section: Core Messagementioning

confidence: 99%

Section: Uv Filtersmentioning

confidence: 99%

Section: Uv Filtersmentioning

confidence: 99%

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Phototoxic and Photoallergic Reactions

Gonçalo

2010

Contact Dermatitis

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“…4 In patients with idiopathic photodermatoses the use of sunscreens is mandatory, however, the sensitization risk from these chemicals may be enhanced by the previous skin inflammation and the need for repeated application for long periods. 7 UV filters, which are chromophores that capture UV light, are among the most frequent causes of PhACD, [8][9][10][11] namely benzophenones, dibenzoylmethane derivatives, octocrylene, and cinammates. 9,10,[12][13][14] Although more recent UV filters seem to be more photostable and less prone to induce PhACD, 3 a few cases have been described, 9 for example, from polysilicone-15 (Parsol ® SLX).…”

Section: This Number Of the Revista Da Sociedade Portuguesa Dementioning

confidence: 99%

Patch and Photo-Patch Testing are Important in Patients with Idiopathic Photodermatoses

Goossens

Gonçalo

2018

SPDV

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This number of the Revista da Sociedade Portuguesa de Dermatologia e Venereologia contains two articles dedicated to idiopathic photodermatoses, for which autoimmune reactions to an unknown endogenous chromophore are suspected to be involved – polymorphous light eruption, actinic prurigo, hydroa vacciniforme, chronic actinic dermatitis, and solar urticarial.1,2 Many of these and other photodermatoses have a very clear clinical presentation, while others may mimic allergic contact dermatitis (ACD) or photo-allergic contact dermatitis (PhACD), a classical T cell-mediated or delayed type IV hypersensitivity reaction to an exogenous chromophore applied on the skin in the presence of, or followed by exposure to ultraviolet (UV) or visible light.3,4 Allergic contact reactions can be followed by persistent photosensitivity and chronic actinic dermatitis, such as in cases of chronic ACD from certain plants, e.g., Compositae that are rich in sesquiterpene lactones,5 fragrances, lichens, and colophony,4 or in PhACD or photo-aggravated ACD from drugs like ketoprofen, etofenamate, and chlorproethazine, or even other contact allergens, such as tosylamide/formaldehyde resin, fragrances, and thiourea derivatives.4The long persistence of these chemicals in the epidermis (for up to at least 17 days in the case of ketoprofen),6 or the formation of endogenous photosensitizers might perhaps explain the progression to chronic actinic dermatitis.4In patients with idiopathic photodermatoses the use of sunscreens is mandatory, however, the sensitization risk from these chemicals may be enhanced by the previous skin inflammation and the need for repeated application for long periods.7 UV filters, which are chromophores that capture UV light, are among the most frequent causes of PhACD,8-11 namely benzophenones, dibenzoylmethane derivatives, octocrylene, and cinammates.9,10,12-14 Although more recent UV filters seem to be more photostable and less prone to induce PhACD,3 a few cases have been described,9 for example, from polysilicone-15 (Parsol®SLX).15 With regard to methylene bis-benzotriazolyl tetramethylbutylphenol (syn. bisoctrizole or Tinosorb® M), ACD from it is due to the surfactant decyl glucoside, in particular, which is added in order to stabilize the sunscreen molecule.16,17Topical drugs, such as the non-steroidal anti-inflammatory ketoprofen, piketoprofen, suprofen, etofenamate, piroxicam, and benzydamine,18 as well as phenothiazine derivatives, i.e., promethazine or chlorproethazine, and isothipendyl chlorhydrate19 are frequent causes of ACD/PhACD, either by direct application or by transfer from other individuals in close contact (consort or connubial dermatitis). Moreover, some of these chemicals, particularly ketoprofen, exhibit cross-reactions with UV filters, i.e., benzophenone(s) and octocrylene, the latter containing benzophenone residues. Also fenofibrate, a systemic drug, shares the benzophenone ring and can cross react with ketoprofen and related molecules.3,20 Furthermore, patients with PhACD from ketoprofen present with concomitant reactions to the perfume ingredient cinnamic alcohol, reactions that at present are difficult to explain by cross-reactivity.21Therefore, patch and photo-patch testing are highly recommended in patients with idiopathic and autoimmune photodermatoses, as well as in all other diseases aggravated by sunlight, in order to detect and avoid exposure to possible aggravating factors, and particularly to UV filters. Recently, recommendations for diagnostic patch testing have been issued by the European Society of Contact Dermatitis (ESCD),22 and in a cooperative effort of the ESCD and European Society of Photodermatology (ESPD), an agreement was not only reached regarding standardized protocols for photo-patch testing,23 but also on the list of 20 allergens to be included in the European baseline photo-patch tests series and an additional extended series including certain classical photo-allergens.24 Last but not least, photo-patch tests with all the patient’s own topical products and systemic photosensitizers to which the patients is exposed are strongly recommended as well, since the outcome may further contribute to the relevance of positive reactions observed, or avoid “false”- negative reactions obtained by testing standardized allergens only.24

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New approach to predict photoallergic potentials of chemicals based on murine local lymph node assay

Maeda

Hirosaki

Yamanaka

et al. 2018

J of Applied Toxicology

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Photoallergic dermatitis, caused by pharmaceuticals and other consumer products, is a very important issue in human health. However, S10 guidelines of the International Conference on Harmonization do not recommend the existing prediction methods for photoallergy because of their low predictability in human cases. We applied local lymph node assay (LLNA), a reliable, quantitative skin sensitization prediction test, to develop a new photoallergy prediction method. This method involves a three-step approach: (1) ultraviolet (UV) absorption analysis; (2) determination of no observed adverse effect level for skin phototoxicity based on LLNA; and (3) photoallergy evaluation based on LLNA. Photoallergic potential of chemicals was evaluated by comparing lymph node cell proliferation among groups treated with chemicals with minimal effect levels of skin sensitization and skin phototoxicity under UV irradiation (UV+) or non-UV irradiation (UV-). A case showing significant difference (P < .05) in lymph node cell proliferation rates between UV- and UV+ groups was considered positive for photoallergic reaction. After testing 13 chemicals, seven human photoallergens tested positive and the other six, with no evidence of causing photoallergic dermatitis or UV absorption, tested negative. Among these chemicals, both doxycycline hydrochloride and minocycline hydrochloride were tetracycline antibiotics with different photoallergic properties, and the new method clearly distinguished between the photoallergic properties of these chemicals. These findings suggested high predictability of our method; therefore, it is promising and effective in predicting human photoallergens.

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Photopatch testing with an extended series of photoallergens: a 5‐year study

Cited by 61 publications

References 19 publications

Phototoxic and Photoallergic Reactions

Phototoxic and Photoallergic Reactions

Patch and Photo-Patch Testing are Important in Patients with Idiopathic Photodermatoses

New approach to predict photoallergic potentials of chemicals based on murine local lymph node assay

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