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Drug-Induced Photosensitivity
Updated: Jun 15, 2017
Author: Alexandra Y Zhang, MD; Chief Editor: Dirk M Elston, MD more...
Background
Drug-induced photosensitivity refers to the development of cutaneous disease as a
result of the combined effects of a chemical and light. [1] Exposure to either the
chemical or the light alone is not sufficient to induce the disease; however, when
photoactivation of the chemical occurs, one or more cutaneous manifestations may
arise. These include phototoxic and photoallergic reactions, a planus lichenoides
reaction, pseudoporphyria, and subacute cutaneous lupus erythematosus.
Photosensitivity reactions may result from systemic medications and topically
applied compounds (see Table 1 below).
UV-Aassociated phototoxicity is also common with vemurafenib, [2, 3, 4] with
reduced UV-A minimal erythema dose in 94% of those tested. [2]
Wavelengths within the UV-A (320-400 nm) range and, for certain compounds,
within the visible range, are more likely to cause drug-induced photosensitivity
reactions, although occasionally UV-B (290-320 nm) can also be responsible for
such effects. UV-B wavelengths are most efficient at causing sunburn and
nonmelanoma skin cancer. In patients who present with photosensitivity, it is often
difficult to differentiate phototoxic from photoallergic reactions. However, they
have a number of distinguishing characteristics (see Table 2 below).
Table 1. Common Photosensitizing Medications (Open Table in a new window)
Photo- Photo- Subacute
Lichenoid Pseudo-
Class Medication toxic allergic Cutaneous Lupus
Reaction porphyria
Reaction Reaction Erythematosus
Tetracyclines (doxycycline,
Antibiotics Yes No Yes Yes No
tetracycline)
Fluoroquinolones
(ciprofloxacin, ofloxacin, Yes No No No No
levofloxacin) [5]
Sulfonamides Yes No No No No
Nonsteroidal anti-
Ibuprofen Yes No Yes No No
inflammatory drugs [6]
Bumetanide No No No Yes No
Acitretin Yes No No No No
Photodynamic therapy
5-Aminolevulinic acid [12] Yes No No No No
prophoto-sensitizers
Phenothiazines (chlorpromazine,
Neuroleptic drugs [15] fluphenazine, perazine, perphenazine, Yes Yes Yes No No
thioridazine) [16]
Thioxanthenes
Yes No No No No
(chlorprothixene, thiothixene)
Hydroxychloroquine No No Yes No No
Enalapril No No No No Yes
Cinnamates No Yes No No No
Benzophenones No Yes No No No
Salicylates No Yes No No No
6-Methylcoumarin No Yes No No No
*3-Hydroxy-3-methylglutaryl
coenzyme A.
Onset of reaction after exposure to agent and light Minutes to hours 24-72 hours
Distribution Sun-exposed skin only Sun-exposed skin, may spread to unexposed areas
Photoallergic reaction.
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