Doxycycline-induced photosensitivity in patients treated for erythema migrans

Abstract

BackgroundDoxycycline is one of the recommended antibiotics for treating erythema migrans (EM). Since EM predominantly occurs during summer, the potential of doxycycline to induce photosensitivity is of concern. In studies on the efficacy of doxycycline for treating relatively small numbers of patients with EM, the reported frequency of photosensitivity has varied from none to 15%. The aim of this study was to elucidate the frequency and clinical symptoms of doxycycline-induced photosensitivity in a large cohort of patients with EM treated in a single medical centre.MethodsProspectively collected data on adverse events were analysed in adult patients with EM treated with doxycycline 100 mg twice daily for 10–15 days.ResultsPhotosensitivity reactions ranging from itching and burning sensations to transient mild erythema of sun-exposed skin were documented in 16/858 (1.9, 95% CI 1.1–3.0%) patients and appeared from June to October with highest frequency in July. These adverse events were more frequent in patients treated for 14 or 15 days (16/750 [2.1%]; 95% CI 1.2–3.4%) than in those treated for 10 days (0/108 [0%]; 95% CI 0.0–3.4%); however, the difference was not significant (P = 0.24). Women were more often affected than men (13/475 [2.7%], 95% CI 1.5–4.6% versus 3/383 [0.8%], 95% CI 0.2–2.3%; P = 0.04). Of the 16 patients who developed photosensitivity, 13 did not adhere to the recommendation to avoid sun exposure. None of the patients had any long-term sequelae of photosensitivity.ConclusionsPhotosensitivity reactions in adult patients with EM treated with doxycycline 100 mg twice daily for 10–15 days occurred rarely, were not severe, and had no long-term sequelae.Trial registrationRegistered at http://clinicaltrials.gov, Identifiers NCT00910715, May 28th 2009, NCT01163994, July 13th 2010 and NCT03584919, June 19th 2018 retrospectively registered.

Tetracyclines and photosensitive skin reactions: A narrative review

“…The majority of studies included patients treated for acne, which considered 2403 patients and 84 photo‐ reactions (65 phototoxic, 27 described as photosensitive and 1 as a sunburn), 14 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 followed by infectious diseases, including: Lyme disease, 31 , 32 , 33 , 34 , 35 , 36 traveler's diarrhea, 37 Gulf Veteran illness. 38 …”

“…After exposition to sunlight (5/6) or hot quartz lamp A study performed in Sweden assess a phototoxic reaction in 1/10 patients exposed to a high intensity sun lamp UVA SUN 2000 after administration on doxycycline 200 mg. 19 A recent phase I phototoxicity study assessed the photo-tests reactions to sarecycline: 12/18 volunteers developed mild erythema at 24 h after UV exposure, while 2/18 48 h after UV exposure. 20 The majority of studies included patients treated for acne, which considered 2403 patients and 84 photo-reactions (65 phototoxic, 27 described as photosensitive and 1 as a sunburn), 14,20-30 followed by infectious diseases, including: Lyme disease, [31][32][33][34][35][36] traveler's diarrhea, 37 Gulf Veteran illness. 38 Between them, 84 photosensitive reactions were observed in 1421 patients.…”

“…The majority of studies included patients treated for acne, which considered 2403 patients and 84 photo-reactions (65 phototoxic, 27 described as photosensitive and 1 as a sunburn), 14,[20][21][22][23][24][25][26][27][28][29][30] followed by infectious diseases, including: Lyme disease, [31][32][33][34][35][36] traveler's diarrhea, 37 Gulf Veteran illness. 38 Between them, 84 photosensitive reactions were observed in 1421 patients.…”