Drug-Induced Photosensitivity – a Continuing Diagnostic Challenge

Abstract

SUMMARY -When taking diff erent drugs, their possible side eff ects on the skin should be considered, including skin reactions connected to photosensitivity. Th is photosensitivity caused by drugs can appear as phototoxic reactions (which occur more often) or photoallergic reactions (which occur less often and include allergic mechanisms). Th e following drugs stand out as medications with a high photosensitivity potential: nonsteroidal anti-infl ammatory drugs (NSAIDs), cardiovascular drugs (such as amiodarone), phenothiazines (especially chlorpromazine), retinoids, antibiotics (sulfonamides, tetracyclines, especially demeclocycline and quinolones), etc. In recent years, photosensitive reactions to newer drugs have appeared, e.g., targeted anticancer therapies such as BRAF kinase inhibitors (vemurafenib, dabrafenib), EGFR inhibitors, VEGFR inhibitors, MEK inhibitors, Bcr-Abl tyrosine kinase inhibitors, etc. In patients taking drugs over a longer period of time (e.g., NSAIDs, cardiovascular drugs, etc.), a particular problem arises when an unrecognized drug-induced photosensitivity on the skin manifests in summer months. When taking patient histories, the physician/dermatovenereologist should bear in mind that any drug the patient is currently taking may be the cause of skin reactions. Th erefore, patients who use potentially photosensitive drugs and treatments on a long term basis should be warned of the possibility of these side eff ects on their skin and advised to avoid direct exposure to sunlight and to use adequate photoprotection. If patients carefully protect themselves from the sun, it is often not necessary to stop treatments that include photosensitive drugs. If such reactions appear, anti-infl ammatory and antiallergic therapies should be introduced.

Doxycycline-Associated Dual Cutaneous Adverse Reaction to the Drug (CARD): Case Report of Concurrent Photosensitivity and Morbilliform Exanthem to Doxycycline

“…The occurrence of these varies. The incidence of photoallergic reactions is low, and phototoxic reactions are high ( The clinical characteristics of photosensitivity drug reactions are summarized in Table 2 [1,3,[9][10][11]. Photoallergic reactions appear as eczematous lesions that can occur on both sun-exposed and non-exposed skin.…”

“…Photosensitivity has been associated with several drugs [1,3]. A morbilliform exanthem has also been observed in patients who are allergic to medication [4].…”

Photosensitivity during apremilast treatment in patients with palmoplantar psoriasis

“…Commonly implicated drugs include nonsteroidal anti‐inflammatory drugs (NSAIDs), antibiotics, and diuretics. Recent advances in therapeutics have led to an increase in frequency of photosensitive reactions with newer drugs such as epidermal growth factor inhibitors, tyrosine kinase inhibitors, and even biologics (e.g., tocilizumab) 3 . Apremilast is increasingly being used in various dermatoses such as DLE, 2 erythema nodosum leprosum, 4 Behcet's syndrome, 5 hidradenitis suppurativa, 6 etc.…”

“…After 2 weeks, the patient developed acute erythema, edema, and mild scaling on the forehead, periorbital, and malar areas sparing the nasolabial folds ( inhibitors, tyrosine kinase inhibitors, and even biologics (e.g., tocilizumab). 3 Apremilast is increasingly being used in various dermatoses such as DLE, 2 erythema nodosum leprosum, 4 Behcet's syndrome, 5 hidradenitis suppurativa, 6 etc. The proposed mechanism of action of apremilast in photosensitivity disorder such as DLE is through the inhibition of Th1 helper cells.…”

<p>Photosensitivity reactions in the elderly population: questionnaire-based survey and literature review</p>

“…Photoallergic reactions have much lower incidence (type IV immune response to light-activated compound is necessary), require smaller doses of drug, and manifest after a longer period of time – the symptoms usually become visible in 24–72 hours after exposure and include pruritic eczematous eruption, erythema, vesicles, lichenification, and scaling. The lesions can also spread to skin areas unexposed to sunlight 6–12…”