Prolonged Photosensitivity following Contact Photoallergy to Ketoprofen

Abstract

We report the third case of prolonged photosensitivity secondary to contact photoallergy to topical ketoprofen, a 2-arylpropionic acid derivative. The patient suffered from persistent photosensitivity for more than 1 year after the withdrawal of ketoprofen with recurrent eruptions on sun-exposed skin areas. This photosensitivity was associated with a persistent decrease in polychromatic and UVA minimal erythemal doses. Photobiological testing revealed cross-reactivity with fenofibrate and benzophenones. Photoallergy to ketoprofen is due to the benzophenone structure or to the very similar thiophene phenylketone of tiaprofenic acid, but not to the arylpropionic function. Thus, fenofibrate, tiaprofenic acid and benzophenones should be avoided by patients with a positive history of photocontact dermatitis to ketoprofen.

Photocontact dermatitis due to dexketoprofen

“…Photocontact dermatitis due to topical ketoprofen was first reported in 1985 in Spain (1), and has since been the subject of several single case reports and series, especially in countries where topical application is popular and/or sun exposure is likely (1)(2)(3)(4)(5). Cross-reactions have been demonstrated between ketoprofen and other arylpropionic derivatives, such as tiaprofenic acid, suprofen, ibuproxam, piketoprofen or flurbiprofen, both clinically and by patch and photopatch testing (2,4,5).…”

“…Photoallergy is due to the benzophenone moiety of ketoprofen, but not to the arylpropionic function (4,6). This induces cross-reactivity to fenofibrate (3,4), unsubstituted benzophenone (4) and benzophenone-containing sunscreens (3), such as benzophenone-3 or benzophenone-10, which should probably not be used in such patients.…”

Study of Compounds Suppressing Free Radical Generation from UV-Exposed Ketoprofen

“…Although the free radical species were speculated to be benzophenone, [9][10][11][12] benzoyl radical, 13) carbonyl radical 14) and superoxide anion, 15) their true identities remain unknown to this day. We elucidated the pathways for the photo-degradation of ketoprofen and the generation of free radicals in our previous study.…”

Photoallergy

“…Subsequently, more cases of PACD caused by other photoallergens like olaquindox and musk ambrette were reported (5)(6)(7)(8)(9). Although persistent light reactivity was also reported with other agents including musk ambrette, hexachlorophene, olaquindox, and ketoprofen (10,11), this entity is now considered a part of CAD spectrum (12)(13)(14)(15)). An association between PACD and CAD exists; however, the underlying mechanisms are unknown and there is little evidence to support a causal relationship (16).…”