High-level ultraviolet A photoprotection is needed to prevent doxycycline phototoxicity: lessons learned in East Timor

Lim, Davin; Murphy, Gillian

doi:10.1046/j.1365-2133.2003.05389.x

Cited by 27 publications

(28 citation statements)

References 5 publications

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“…In countries with high solar radiation phototoxic reactions to doxycycline are more frequent even at lower doses. In a United Nations peacekeeping deployment to East Timor, a group of islands within the Malaysian archipelago, 22 of 135 (16%) Australian troops exhibited phototoxic reactions to doxycycline 100 mg daily [13]. However, in children, even very low doses of doxycycline may cause phototoxicity.…”

Section: Frequency Of Phototoxic Side Effects and Dependence On Dose mentioning

confidence: 99%

“…The main spectrum of wavelength causing phototoxic reactions seems to be UVA1 (340-400 nm) [13,14] while the minimal dose of UV light, being able to provoke a significant increase of erythema reaction compared to placebo, seems to be around 50 J/cm 2 (investigated doses were 25, 50, 75, and 100 J/cm 2 , whereas no significant increase of erythema reaction was found at 25 J/cm 2 ) as detected by Bjellerup and Ljunggren [14] using a UVA system emitting mainly between 345 and 445 nm, with a peak at 370 nm. Nevertheless, doxycycline may also lead to a reduction of the minimal erythema dose in the spectrum of UVB [4].…”

Section: Frequency Of Phototoxic Side Effects and Dependence On Dose mentioning

confidence: 99%

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Phototoxicity of Doxycycline: A Systematic Review on Clinical Manifestations, Frequency, Cofactors, and Prevention

Goetze¹,

Hiernickel²,

Elsner³

2017

Skin Pharmacol Physiol

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Background: One of the most important dermatologic side effects of doxycycline is photosensitivity. As doxycycline is important for malaria prophylaxis and malaria is mainly spread in countries with high sun radiation, special attention should be paid to this adverse effect. While there are many publications on the phototoxicity of tetracyclines in general, only a few exist focusing on doxycycline. The objective of this systematic review was to summarize all available reports on clinical manifestations, influencing factors like UV dose or dose of medication, and the possibilities of prevention by sun protection. Methods: This review is based on a systematic search in PubMed for articles in English and German and a manual search between 1990 and 2015. Results: The number of publications is low. Clinical symptoms vary from light sunburn-like sensation (burning, erythema) to large-area photodermatitis. Also, onycholysis is possible. The triggering UV spectrum seems to consist mainly of UVA1 (340-400 nm), so UV-protective products should be used that cover this range. Travelers to tropical countries taking doxycycline for malaria prophylaxis need thorough medical counseling to avoid possibly severe phototoxic reactions. Conclusion: Evidence base must be improved for giving advice on appropriate prevention measures to travelers taking doxycycline and having a risk of significant sun exposure.

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Section: Frequency Of Phototoxic Side Effects and Dependence On Dose mentioning

confidence: 99%

Section: Frequency Of Phototoxic Side Effects and Dependence On Dose mentioning

confidence: 99%

Phototoxicity of Doxycycline: A Systematic Review on Clinical Manifestations, Frequency, Cofactors, and Prevention

Goetze¹,

Hiernickel²,

Elsner³

2017

Skin Pharmacol Physiol

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“…In patients taking 100 mg/day of doxycycline, a phototoxic reaction was observed in 16% of patients (n=135). 4 In patients taking a 150 mg/day dose, the incidence was 20% (n=30). 5 In patients taking 200 mg/day of doxycycline, the incidence varied among studies, but was observed to be as high as 42% in a study comparing 150 mg to a 200 mg per day dose (n=76).…”

Section: Introductionmentioning

confidence: 99%

“…3 The clinical presentation of doxycycline induced phototoxicity may vary from a sunburn-like sensation to diffuse erythematous plaques on sun-exposed areas. 4,5 The rash generally resolves within 10-14 days after discontinuation of the drug. 5 In addition, several case reports of onycholysis due to doxycycline induced phototoxicity have been described in adults and children.…”

Section: Introductionmentioning

confidence: 99%

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Evolution of a Doxycycline-Induced Phototoxic Rash With an Unusual Distribution

2018

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Commonly used in clinical practice, doxycycline has been known to produce a cutaneous phototoxic reaction in combination with sunlight. Several mechanisms have been proposed to contribute to its pathogenesis such as UVA oxidation of cellular components, the formation of photoproducts, and altered melanogenesis. We describe a case of a phototoxic rash in a patient taking doxycycline 100 mg daily for the treatment of rosacea. We present several photos of the rash from erythema to desquamation several weeks later. The clinical presentation of a doxycycline-induced phototoxic rash varies from a sunburn like sensation to diffuse erythematous plaques on sun exposed areas. Treatment involves discontinuing the drug and providing symptomatic relief. Although sunscreen may prevent a doxycycline-induced phototoxic reaction, it is important to educate the patient to use a sunscreen with protection in the 340-400 nm range in which phototoxic reactions are thought to occur. As doxycycline-induced phototoxicity is poorly understood, it may be best to advise the patient to avoid sun exposure altogether while taking the drug.

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Cutaneous Photosensitivity Diseases

Ibbotson

Dawe

2016

Rook's Textbook of Dermatology, Ninth Edition

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The photodermatoses are a diverse group of diseases, some of which, such as polymorphic light eruption, are very common and others, such as hydroa vacciniforme or xeroderma pigmentosum, are rare. It is essential not to miss the diagnosis of these conditions and referral to a specialist photodiagnostic centre is advised for many patients. Management depends on the diagnosis but includes prevention and disease suppression. Photoprotection is a mainstay approach for the photodermatoses but is often not sufficient for disease control. Desensitization using photo(chemo)therapy regimens may be feasible and systemic therapies are sometimes needed. Photosensitivity, particularly if chronic and severe, can be associated with significant psychological morbidity, which must be considered. Awareness of the possibility of vitamin D deficiency is also required.

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High-level ultraviolet A photoprotection is needed to prevent doxycycline phototoxicity: lessons learned in East Timor

Cited by 27 publications

References 5 publications

Phototoxicity of Doxycycline: A Systematic Review on Clinical Manifestations, Frequency, Cofactors, and Prevention

Phototoxicity of Doxycycline: A Systematic Review on Clinical Manifestations, Frequency, Cofactors, and Prevention

Evolution of a Doxycycline-Induced Phototoxic Rash With an Unusual Distribution

Cutaneous Photosensitivity Diseases

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