Photosensitivity to lomefloxacin. A clinical and photobiological study

Abstract

Photosensitivity is an uncommon but characteristic side effect of quinolones, with a variable incidence for the different drugs. Several cases, considered either phototoxic or photoallergic, have been described with lomefloxacin use. During the last 4 years we studied 8 patients (mean age 69.4 years) with eczematous or acute sunburn-like lesions in photo-exposed areas, after taking lomefloxacin for a period of one week to several months. After drug withdrawal and systemic and/or topical corticosteroids, lesions cleared within one week to two months, with dischromia in one patient. Six to eight weeks thereafter, a photobiological study was performed. Minimal erythema dose (MED) for UVA and UVB were normal and photopatch tests with lomefloxacin, ofloxacin, ciproflaxacin and norfloxacin, tested at 1%, 5% and 10% in petrolatum and irradiated with 5 and 10 J/cm2 UVA were negative in 7 patients and 20 controls. Patient 1 had a positive photopatch test with lomefloxacin. One patient, who inadvertently reintroduced the drug before photopatch testing, developed a sharply limited erythematous reaction at 48 h in all irradiated areas, without aggravation at the sites of the quinolones patches. Our patients illustrate the polymorphism of clinical photosensitivity to lomefloxacin and represent the largest series in which photobiological studies have been performed. As in previous reports there are arguments favouring photoallergy, but phototoxicity appears to be the main mechanism of photosensitivity to quinolones, particularly in older patients with concomitant diseases and long-term use of the drug.

Skin DNA photodamage and its biological consequences

“…For example, antibiotics, psoralens, nonsteroidal anti-inflammatory drugs, and tranquilizers have been described as inducing such unwanted side effects. 25,26 As shown in Fig 2, photogenotoxicity (together with possible long-term effects [eg, photocarcinogenicity]) can arise through a direct reaction of a photoactivated molecule with DNA, or through oxidative reactions.…”

In Vitro Phototoxic Properties of Triamcinolone 16,17-acetonide and Its Main Photoproducts¶

“…Intramuscular and topical administration of triamcinolone, generally dispensed as the more potent acetonide derivative (16α,17α‐cyclic ketal or isopropylidene derivative), are successfully used for the treatment of dermatoses (2,3) and, in particular, of psoriasis (4,5), one of the few inflammatory dermatoses that does not respond to largely used topical steroids. Furthermore, this corticosteroid is used against drug‐induced erythema (6) and for the topical chemotherapy of pigment abnormalities in surgical patients (7). However, in this last application a moderate photoallergy has been noted, and, furthermore, it is known that this drug photobinds to the human mineralocorticoid receptor (8).…”

Photosensitivity induced by paroxetine

“…Drug‐induced photosensitivity (1) is more frequent in southern Europe because of greater sun exposure (2). Nevertheless, considering the daily use of such drugs, we would agree with Darvay et al.…”