Severe phototoxicity associated with long‐term voriconazole treatment

Vöhringer, Sabine; Schrum, Johanna; Ott, Hagen; Höger, P.

doi:10.1111/j.1610-0387.2010.07563.x

Cited by 26 publications

(17 citation statements)

References 9 publications

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“…As with other azoles, there have been a few reports of serious hepatotoxicity. Skin rashes have been reported, with distribution over sun-exposed areas, consistent with phototoxic reactions (186). Chronic skin inflammation associated with this exposure appears to promote skin cancer, including squamous cell carcinoma and melanoma (189)(190)(191).…”

Section: Advances In Antifungal Therapy For Coccidioidomycosismentioning

confidence: 85%

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Recent Advances in Our Understanding of the Environmental, Epidemiological, Immunological, and Clinical Dimensions of Coccidioidomycosis

et al. 2013

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SUMMARY Coccidioidomycosis is the endemic mycosis caused by the fungal pathogens Coccidioides immitis and C. posadasii . This review is a summary of the recent advances that have been made in the understanding of this pathogen, including its mycology, genetics, and niche in the environment. Updates on the epidemiology of the organism emphasize that it is a continuing, significant problem in areas of endemicity. For a variety of reasons, the number of reported coccidioidal infections has increased dramatically over the past decade. While continual improvements in the fields of organ transplantation and management of autoimmune disorders and patients with HIV have led to dilemmas with concurrent infection with coccidioidomycosis, they have also led to advances in the understanding of the human immune response to infection. There have been some advances in therapeutics with the increased use of newer azoles. Lastly, there is an overview of the ongoing search for a preventative vaccine.

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Section: Advances In Antifungal Therapy For Coccidioidomycosismentioning

confidence: 85%

“…Uniquely, visual disturbances are commonly seen in a 2-to 4-h time window coinciding with the peak concentration (184)(185)(186)(187). There are reports of hallucinations and other psychiatric events.…”

Section: Advances In Antifungal Therapy For Coccidioidomycosismentioning

confidence: 99%

Recent Advances in Our Understanding of the Environmental, Epidemiological, Immunological, and Clinical Dimensions of Coccidioidomycosis

et al. 2013

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“…The nature of the skin lesions we observed appeared to be highly characteristic of voriconazole skin toxicity. However, the time frame at which the skin reactions developed after starting voriconazole with concomitant MTX in our patients was much shorter (median, 36 days) than the reporting time frame in which toxicity can develop during voriconazole monotherapy (generally Ͼ3 months) (11).…”

Section: Casementioning

confidence: 63%

Severe Skin Toxicity in Pediatric Oncology Patients Treated with Voriconazole and Concomitant Methotrexate

Hasselt

Eijkelenburg

Huitema

et al. 2013

Antimicrob Agents Chemother

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dWe report the occurrence of skin toxicities in pediatric oncology patients on concomitant treatment with voriconazole and methotrexate (MTX). Of 23 patients who received this combination, 11 patients suffered from cheilitis and/or photosensitivity. In contrast, only in 1 of 9 patients who received voriconazole without MTX was photosensitivity observed. A mechanism of action was not able to be identified. We describe two cases with severe skin toxicities. Caution is warranted when using voriconazole and concomitant MTX. Due to an increased risk of fungal exposure (specifically Aspergillus) caused by unavoidable construction activities in our hospital, immunocompromised pediatric patients treated for hematologic malignancies and autologous stem cell transplantation recipients received antifungal prophylaxis with oral voriconazole Strikingly, during the time period of this prophylaxis, increased incidence and severity of skin toxicities were observed in patients treated concomitantly with high-(HD) or low-dose (LD) methotrexate (MTX). This drew our attention, since antifungal prophylaxis with voriconazole was generally not used prior to the construction activities and the nature of skin lesions appeared to be different from that of the typical skin reactions induced by only methotrexate in these patients (1-3).Therefore, we have performed a systematic chart review in all patients treated with prophylactic voriconazole as recorded in the electronic hospital medication registration database within a period of 6 months (January 2011 to June 2011). Toxicities (photosensitivity and cheilitis) were graded according to CTCAE criteria (v4.0) (4). To illustrate our observations, we have described the observed toxicity for two patients in more detail.A total of 32 patients received antifungal prophylaxis with voriconazole, most of whom were treated for acute lymphoblastic leukemia (ALL). In 23 of these patients (17 males, 6 females; 0 to 17 years old; median, 10 years of age), MTX was concomitantly administered as part of their treatment. An overview of all included patients is provided in Table 1. In 11 of 23 patients (48%) receiving prophylactic voriconazole and concomitant MTX, skin toxicities were observed. All of these patients (9 male, 2 female) experienced photosensitivity (grade 1 to 3), whereas 6 patients also experienced cheilitis (grade 2 to 3). In contrast, in patients receiving voriconazole treatment without concomitant MTX, only 1 of 8 patients experienced a skin reaction (photosensitivity grade 3) and no patient experienced cheilitis.The skin reactions most often erupted within a short time period after MTX treatment was given concomitantly (median time after the start of voriconazole, 36 days; range, 5 to 94 days) and typically presented as a painful erythema on sun-exposed areas of hands, face, and neck and with evolution of crustae on the lips. Mucositis, which is a typical high-dose-MTX-associated toxicity, was generally not observed in these patients during the observation period. Some skin reactions of ...

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“…22 An 8-year-old boy developed severe phototoxicity after taking voriconazole for treatment and prophylaxis after pulmonary aspergillosis for 1 year; he developed a blistering eruption on his face after minimal sunlight exposure. 23 The association of voriconazole with blistering of the skin after allogeneic haemopoietic stem cell transplantation may be difficult to establish, and the diagnosis can be delayed when there is a history of graft-versus-host disease. 24 It is important to recognize voriconazole-induced blistering as a separate and distinct entity in patients with a history of graft-versus-host disease, as delayed withdrawal of voriconazole can cause unnecessary and potentially dangerous increases in immunosuppressive drug therapy.…”

Section: Mechanisms and Susceptibility Factorsmentioning

confidence: 99%

Photosensitivity reactions and skin tumours associated with voriconazole

Aronson¹

2015

Adverse Drug Reaction Bulletin

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Use of voriconazole, a triazole antifungal drug, has often been associated with photosensitivity, and this adverse reaction has been linked to a risk of tumours in light-exposed areas, especially squamous cell carcinomas, but also melanomas. The mechanisms by which voriconazole causes these effects are not clear, but susceptibility factors for a predisposition to skin cancers include duration of use, immunosuppression, ultraviolet (UV) exposure, advanced age, and skin type. Voriconazole should be used carefully, particularly in patients with susceptibility factors for skin cancer. If prolonged voriconazole therapy is required, it is advisable to have frequent diligent skin examinations, to avoid excess sunlight, and to use UV protectants liberally.

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Severe phototoxicity associated with long‐term voriconazole treatment

Cited by 26 publications

References 9 publications

Recent Advances in Our Understanding of the Environmental, Epidemiological, Immunological, and Clinical Dimensions of Coccidioidomycosis

Recent Advances in Our Understanding of the Environmental, Epidemiological, Immunological, and Clinical Dimensions of Coccidioidomycosis

Severe Skin Toxicity in Pediatric Oncology Patients Treated with Voriconazole and Concomitant Methotrexate

Photosensitivity reactions and skin tumours associated with voriconazole

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