Drug-Induced Photosensitivity—From Light and Chemistry to Biological Reactions and Clinical Symptoms

Abstract

Photosensitivity is one of the most common cutaneous adverse drug reactions. There are two types of drug-induced photosensitivity: photoallergy and phototoxicity. Currently, the number of photosensitization cases is constantly increasing due to excessive exposure to sunlight, the aesthetic value of a tan, and the increasing number of photosensitizing substances in food, dietary supplements, and pharmaceutical and cosmetic products. The risk of photosensitivity reactions relates to several hundred externally and systemically administered drugs, including nonsteroidal anti-inflammatory, cardiovascular, psychotropic, antimicrobial, antihyperlipidemic, and antineoplastic drugs. Photosensitivity reactions often lead to hospitalization, additional treatment, medical management, decrease in patient’s comfort, and the limitations of drug usage. Mechanisms of drug-induced photosensitivity are complex and are observed at a cellular, molecular, and biochemical level. Photoexcitation and photoconversion of drugs trigger multidirectional biological reactions, including oxidative stress, inflammation, and changes in melanin synthesis. These effects contribute to the appearance of the following symptoms: erythema, swelling, blisters, exudation, peeling, burning, itching, and hyperpigmentation of the skin. This article reviews in detail the chemical and biological basis of drug-induced photosensitivity. The following factors are considered: the chemical properties, the influence of individual ranges of sunlight, the presence of melanin biopolymers, and the defense mechanisms of particular types of tested cells.

NRF2 in dermatological disorders: Pharmacological activation for protection against cutaneous photodamage and photodermatosis

“…Thus, related problems can arise from both the amplification of oxidative stress and immune imbalance that are already induced by UVR. These drugs include commonly used agents, such as the cholesterol lowering statins (simvastatin and atorvastatin), thiazides and other anti-hypertensive drugs as well as some antibiotics (e.g., Tetracyclines) [ 216 ]. As some of the drugs are lifesaving or taken for a considerably long periods of time, reduced quality of life due to visual symptoms, as well restricted outdoor activities, is seen [ 217 , 218 ].…”

The Assessment of Meloxicam Phototoxicity in Human Normal Skin Cells: In Vitro Studies on Dermal Fibroblasts and Epidermal Melanocytes

“…Drug-induced photosensitivity reactions are based on the mechanism of action of a given drug, the administered dose, and genetic predisposition, which may result in serious, irreversible skin cells damage [6,7]. Taking presented facts into consideration, skin ADRs usually require additional medical care, e.g., hospitalization and generate significant costs for health care systems [8]. Moreover, the skin-related ADRs are also the cause of patients' comfort decreasing and may lead to limitations in pharmacotherapy effectiveness [1].…”

“…Phototoxic reactions are characterized by their occurrence after a short time (minutes to a few hours) after sun exposure, their appearance after the first exposure to a photosensitive agent, their dose-dependent effect and the necessity of high photosensitizer concentration [8].…”

Changes in the Oxidation-Reduction State of Human Dermal Fibroblasts as an Effect of Lomefloxacin Phototoxic Action

“…Both the UVA/UVB ratio and UV irradiance are determined by various factors, such as altitude, time of day, latitude, and season. In addition, there are many artificial sources of UVA radiation, such as sunbeds, lamps intended for phototherapy, or photocuring [ 6 ]. Photoactive drugs are able to absorb normally innocuous levels of radiation, creating harmful photoproducts.…”