Many drugs may cause the skin to be more sensitive to light during or after their use. Photosensitivity may manifest in two forms either as a photoallergic or phototoxic reaction. Phototoxicity may arise as a result of damage to skin cells by the drug's light-activated chemical. In contrast, photoallergic reaction may occur as a result of a cell mediated response to light-activated chemical that acts as an anti-gen.3,5,22,23,30,31
Phototoxicity is by far the most common reaction experienced by those individuals that are susceptible to drug-induced photosensitivity, while photoallergic reaction is less common but usually severe. Phototoxicity commonly manifests in a matter of minutes or hours as sunburn, which may lead to blistering of the skin in severe cases. However, photoallergic reaction may appear after a day or so as a severe itchy rash where the skin was exposed to light that may occasionally spread to unexposed skin.3,5,22,23,30,31
Below are some of the drugs that have been found or reported to cause photosensitivity. (This list comprises only those drugs that are FDA approved and available on the US market.)
“Reported” indicates that photosensitivity has been observed in either post-marketing reports or no sufficient data are available to determine the frequency.
FrishmanW.H., BrosnanB.D., Grossman M; DasguptaD., SunA.D.Adverse dermatologic effects of cardiovascular drug therapy: part I. Cardiol Rev.2002; 10(4): 230–246.
Cardizem LA [package insert].Biovail Pharmaceuticals; 2004.
5.
TaylorC.R.Photosensitivity: classification, diagnosis, and treatment. Dermatol Nurs.1998; 10(5): 323–330.
6.
RacetteA.J., RoenigkH.H., HansenR., MendelsonD, ParkA.Photoaging and phototoxicity from long-term voriconazole treatment in a 15-year-old girl. J Am Acad Dermatol.2005; 52(5 suppl): S81–S85.
7.
FrishmanW.H., BrosnanB.D., GrossmanM., DasguptaD., SunD.K.Adverse dermatologic effects of cardiovascular drug therapy: part II. Cardiol Rev.2002; 10(5): 285–300.
EnginB., OguzO.Evaluation of time-dependent response to psoralen plus UVA (PUVA) treatment with topical 8-methoxypsoralen (8-MOP) gel in palmoplantar dermatoses. Int J Dermatol.2005; 44(4): 337–339.
TreudlerR., GeorgievaJ., GeilenC.C., OrfanosC.E.Dacarbazine but not temozolomide induces phototoxic dermatitis in patients with malignant melanoma. J Am Acad Dermatol.2004; 50(5): 783–785.
14.
Dexchlorpheniramine [package insert]. Morton Grove Pharmaceuticals; 2002.
LeoneR., VenegoniM., MotolaD.. Adverse drug reactions related to the use of fluoroquinolone antimicrobials: an analysis of spontaneous reports and fluoroquinolone consumption data from three Italian regions. Drug Saf.2003; 26(2): 109–120.
LimD.S., MurphyG.M.High-level ultraviolet A photoprotection is needed to prevent doxycycline phototoxicity: lessons learned in East Timor. Br J Dermatol.2003; 149(1): 213–214.
23.
MorisonW.L.Solar urticaria due to progesterone compounds in oral contraceptives. Photodermatol Photoimmunol Photomed.2003; 19(3): 155–156.
LimD.S., TriscottJ.O'Brien's actinic granuloma in association with prolonged doxycycline phototoxicity. Australas J Dermatol.2003; 44(1): 67–70.
28.
MooreD.E.Drug-induced cutaneous photosensitivity: incidence, mechanism, prevention and management. Drug Saf.2002; 25(5): 345–372.
29.
MillardT.P., HawkJ.L.Photosensitivity disorders: cause, effect and management. Am J Clin Dermatol.2002; 3(4): 239–246.
30.
Azulfidine [package insert].Pharmacia; 2002
31.
SelvaagE., PetersenA.B., GniadeckiR., ThornT., WulfH.C.Phototoxicity to diuretics and antidiabetics in the cultured keratinocyte cell line HaCaT: evaluation by clonogenic assay and single cell gel electrophoresis (Comet Assay). Photodermatol Photoimmunol Photomed.2002; 18(2): 90–95.
32.
CorreiaO., LombaV.H., AzevedoR., DelgadoL., PoloniaJ.Possible phototoxicity with subsequent progression to discoid lupus following pantoprazole administration. Clin Exp Dermatol.2001; 26(5): 455–456.
33.
BagheriH., LhiaubetV., MontastrucJ.L., Chouini-LalanneN.Photosensitivity to ketoprofen: mechanisms and pharmacoepidemiological data. Drug Saf.2000; 22(5): 339–349.
34.
GeorgeM.Methylene-blue-induced hyperbilirubinemia and phototoxicity in a neonate. Clin Pediatr.2000; 39(11): 659.
MoyerD.B.Continued treatment with fluorouracil for colon cancer despite severe phototoxic dermatitis. J Allerg Clin Immunol.1996; 97(1, part 3): 341.
37.
McKennaK.E., SternR.S.Photosensitivity associated with combined UV-B and calcipotriene therapy. Arch Dermatol.1995; 131(11): 1305–1307.
38.
YoshimotoE., KonishiM., TakahashiK.. The first case of efavirenz-induced photosensitivity in a Japanese patient with HIV infection. Intern Med.2004; 43: 630–631.
KoppelR.A., BohE.E.Cutaneous reactions to chemotherapeutic agents. Am J Med Sci.2001; 321(5): 327–335.
81.
FryeC.B., PettigrewT.J.Angioedema and photosensitive rash induced by valsartan. Pharmacotherapy.1998; 18(4): 866–868.
82.
FrishmanW.H., BrosnanB.D., GrossmanM., DasguptaD., SunD.K.Adverse dermatologic effects of cardiovascular drug therapy: part III. Cardiol Rev.2002; 10(6): 337–348.
EichD; Scharffetter-KochanekK., EichH.T., Tantcheva-PoorI., KreigT.Acral erythrodysesthesia syndrome caused by intravenous infusion of docetaxel in breast cancer. Am J Clin Oncol.2002; 25(6): 599–602.
