Photosensitivity induced by naproxen

Abstract

We present two cases of systemic photosensitivity due to naproxen that presented as photodistributed erythema multiforme (EM) and lichenoid photodermatitis (LP). Although naproxen is a commonly used nonsteroidal antinflammatory drug and has the capacity of causing systemic photosensitivity, there are very few reports about it in the literature. The diagnosis was suspected by the recent ingestion of the drug and the photodistribution of the lesions. A positive photopatch test in the first patient and the normalization of the MED-UVB after discontinuing naproxen in the second patient supported the diagnosis.

Drug and chemical induced photosensitivity from a clinical perspective

“…Other less common mechanisms of drug-induced photosensitivity may be through the route of drug-induced lupus, such as with calcium antagonists, thiazides, angiotensin converting enzyme inhibitors (ACEI), beta blockers, terbinafine, NSAIDs, proton pump inhibitors, TNF alpha antagonists and cytotoxics (25)(26)(27)(28). Other presentations are as erythema multiforme, a lichenoid reaction and pellagra (29,30). Indeed, the same drug or drug class may induce diverse types of photosensitivity reaction in different subjects, such as photodistributed papulovesicular reactions, exaggerated erythema and lichenoid change seen in cases of fenofibrate photosensitivity (31).…”

Unveiling the Photophysical and Photochemical Reaction Process of Naproxen via Ultrafast Femtosecond to Nanosecond Laser Flash Photolysis

“…2 NPX, as an example, severely damages cell components and can lead to DNA photocleavage, 3−5 red blood cell photohemolysis, 6 and lipid peroxidation 7,8 after photoexitation, which will lead to various cutaneous phototoxic responses to some patients. 9 In previous reports, 3−8 although many studies have aimed to elucidate the phototoxic mechanisms of DNA photocleavage, photohemolysis, and lipid peroxidation induced by NPX, the phototoxic mechanisms mentioned in these works are conflicting. NPX triplet state intermediates, NPX radicals, superoxide, singlet oxygen, and hydroxy radical have been proposed to be involved in the phototoxicity mechanisms, but the precise forms of the intermediates that caused phototoxic side effects were not detected in those experiments involving the use of different kinds of quenchers.…”

“…However, most of NSAIDs are photosensitive, giving rise to phototoxic side effects to human beings . NPX, as an example, severely damages cell components and can lead to DNA photocleavage, − red blood cell photohemolysis, and lipid peroxidation , after photoexitation, which will lead to various cutaneous phototoxic responses to some patients . In previous reports, − although many studies have aimed to elucidate the phototoxic mechanisms of DNA photocleavage, photohemolysis, and lipid peroxidation induced by NPX, the phototoxic mechanisms mentioned in these works are conflicting.…”

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

“…Skin reactions include edema, bullae, dermatitis, erythema multiforme, dyshidrosis, scattered erythematous papules, and vesicles on the face and dorsum of the hands. Diclofenac has also been reported to cause phototoxic fingernail onycholysis 7,42,56–60…”