Drug-induced photosensitivity

Drug-induced photosensitivity : Photosensitivity is an exaggerated or abnormal response of the skin to sunlight or to an artificial source of ultraviolet rays . There is a wide range of medicines and chemicals that are capable of inducing a skin reaction after exposure, sometimes minimal, to light radiation, causing a skin reaction that can cause a severe condition. These reactions can be difficult to diagnose because of their resemblance to severe sunburn. It is important to note that approximately 8% of the adverse effects of medications are reactions of this type.

Table of Contents

Summary

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1 Features
2 Drug-induced phototoxic reaction
3 Drug-induced photoallergic reaction
4 Drugs that cause these reactions
- 1 PHOTOSENSITIZERS FOR TOPICAL USE
- 2 PHOTOSENSITIZERS FOR SYSTEMIC USE
5 What is recommended to avoid these reactions
6 What to do
7 Sources

characteristics

In summary, drug-induced photosensitivity is characterized by:

Presence of drug on the skin.
Absorption of photons of a certain wavelength (most photosensitizing drugs are in the ultraviolet A (UV-A) radiation range (320-400nm) with some extension to ultraviolet B (UV-B) radiation (290 -320 nm), since these wavelengths are related to burns caused by sunlight).
Development of a skin lesion by the combination of the two aforementioned effects.

Photosensitivity can manifest as phototoxic reactions and as photoallergic reactions , depending on the pathophysiological mechanism and clinical manifestations. It should be noted that both can occur at the same time.

Drug-induced phototoxic reaction

The phototoxic reaction is a non-immune photosensitivity reaction caused by drugs and other chemicals. These types of reactions are the photosensitivity reactions most frequently caused by drugs (95%). In this process, which requires a high concentration of the drug in the skin, free radicals are formed, which, combined with oxygen, generate highly reactive and cytotoxic superoxide anions and hydroxyl radicals. These reactions do not require prior sensitization and are more frequent with orally administered drugs.

Phototoxicity appears after a few minutes or a few hours of contact with the drug. It is characterized by the presence of erythema, edema, vesicles, itchy blisters, and presents with a clinical manifestation similar to burns caused by excessive exposure to the sun. These lesions appear in areas exposed to light and can revert in 2-7 days after stopping the drug. However, some episodes are resolved with marked hyperpigmentation that can last for months. Other clinical manifestations have been described, including: photooncolysis, slate gray pigmentation, lichenoid eruption, pseudoporphyria, and progression to chronic actinic dermatitis.

Drug-induced photoallergic reaction

Photoallergic reactions are photosensitivity reactions involving the immune system that cause a type IV hypersensitivity reaction. These reactions require prior exposure to the photosensitizing drug and its chemical transformation by UV radiation. The drug is transformed into a hapten that when combined with skin proteins forms a new antigen, thus generating the immune reaction. These reactions are very rare and show a late response, between 1-14 days post-exposure. They manifest clinically with an eczematous-type inflammatory reaction if the drug is applied topically, or with a rash if administration has been systemic. Cross-reactions between similar drugs can occur and sensitization can be permanent.

Drugs that cause these reactions

PHOTOSENSITIZERS FOR TOPICAL USE

Vegetable products that enter the cosmetic composition: artichoke, celery, carrot, lemon, lavender, cedar (perfumes, ointments)
Furocoumarins: psoralen, quinine (bergamot, hair lotions, tonics)
Para-aminobenzoic acid (sunscreens)
Dyes (eosin, methylene blue fluorescein, rose bengal)
Medicines for local use: 5 fluoro-uracil (Efudix)
Acid vitamin A, acne treatment (Acnisdín)
Bacteriostatic deodorants (Rexona)
Hexachlorophene: disinfectant (Dermisone OL-1, Neo-visage, Sevaeen)
Trichlorocarbanilide (Talgo, Dental)
Anti-histamine ointments (Fenergan)
Solar filters with Psoralenos (Bergasol).

PHOTOSENSITIZERS FOR SYSTEMIC USE

– ACNE MEDICATIONS • Tretinoin (Retin-A)

– SULFAMIDES • Sulfaguanidine (Bisolvan-sulfa, Bronco-aseptilex, Bronchidiazine, Bronchiosedans)

Sulpiridine (Dixibon)
Sulfatiazol (Bucobrin, Ovulaseptil, Vaginocrem)
Sulfadimethoxine (Madribon)
Trimetroprim (Abactrim, Balsoprim, Bi-sulfachemi, Septrin)

– ANTI-CANCER DRUGS

Dacarbazine (DTIC-Dome)
Fluorouracil (Fluoroplex, Efudix)
Methotrexate (Mexate)
Vinblastine (Veiban)

– ANTIDEPRESSANTS

Amitriptyline (Elavil)
Desipramine (Norpramin, Petrofrane)
Doxepin (Adapin, Sinequan)
Imipramine (Tofranil, Paidenur)
Notriptyline (Aventyl, Pamelor)
Protriptyline (Vivactil)
Trimipramine (Surmontil)

– ANTIHISTAMINES AND PHENOLTHIAZINES

Claritin (Loratidine)
Chlorpromazine (Largactil, Febrilone)
Cyproheptadine (Periactin)
Diphenhydramine (Benadryl, Caladril, Histafilin, Pallidan, Predio, Rinocusi-desg, Soñodor, Talquistina)
Perphenazine (Decentan, Deprelio)
Promethacin (Actithiol, Rinomycin-R, Antihemorroi-H, Fenergan)
Thioridazine (Meleril)
Triflupromazine (Siquil)

– ANTI-INFLAMMATORIES

Phenylbutazone (Tanderil)
Indomethacin (Indocid)
Naproxen

– ANTITUBERCULOSOS

Isoniazida (Cemidon, Estrepto-sinerge; Hay-vit 150, Hidramicin, Hidracida, Isoniacid, Myambutol, Rimifon)

– ANTIBIOTICS

Oxolinic acid (Urirtrate)
Demaclocycline (Declomycin)
Doxycycline (Vibramycin)
Griseofulvin (Fulvicin-U / F, Fulcin)
Methacycline (Rondomycin)
Nalidixic acid (NegGram, Wintomylon)
Oxytetracyclines (Terramycin)
Sulfacyntine (Renoquid)
Sulfamethazine (Neotrizine)
Sulfamethizole (Thiosulfil)
Sulfamethoxazole (Gantanol)
Sulfamethoxazole-trimethoprim (Bactrim, Septra)
Sulfasalazine (Azulfidine)
Sulfatiazol
Sulfisoxazole (Gantrisin)
Tetracyclines (Achromysin, Minocin)

– ANTIMALÁRICOS

Chloroquine (Nivaquine, Resochin, Orobutazol)

– ANTIPSYCHOTIC DRUGS

Chlorpromazine (Thorazine)
Flufenacin (Permitil, Prolixin)
Haloperidol (Haldol)
Perphenazine (Trilafon)
Piperacetacina (Quide)
Prochlorperazine (Compazine)
Promethacin (Phenergan)
Thioridacna (Mellaril)
Trifluoperazine (Stelazine)
Triflupromazine (Vesprin)
Trimeprazine (Termaril)

– DRUGS USED TO RELIEVE ANXIETY

Amantadine (Amantadine-abello, Protexin)
Chlordiazepoxide (Librax, Librium, Omnalio, Paliatin, Relaxedans, Templax)
Cyproheptadine (Biomax, Campocomplex, Cubolic, Fidestonic, Periactan, Stolina, Viternum)
Nitrazepam(Mogadon, Pelson, Serenade, Painedur)

– ANTIARRHYTHMICS

Quinidine (Cardioquine, Natisedine, Neo-anrtmaline)
Amiodarone (Ansiocor, Traneorex)

– PSYCHOMOTORS

Piritinol (Acinetil drinkable, Bonifen, Cefalocatavin, Plenumil, Refulgin, Vitabonifen)

– DIURETICS

Bendroflumethiazide (Naturetin)
Bentiacide (Exna)
Chlorothiazide (Diuril, Saluretil, Dourosulfone)
Cyclothiazide (Anhydron)
Furosemide (Lasix)
Hydroflumetiazide (Diucardin)
Hydrochlorothiazide (Ameride, Adelfan-esidrex, Hidrosaluretil Rauplex, Picten)
Methylclothiazide (Aquatensen, Enduron)
Metolazone (Diulo, Zaroxolyn)
Polythiazide (Renese)
Quinetazone (Hydromox)
Trichlormethiazide (Metahydrin)
Thiazides (Diuril; Hydrodiuril)

– SWEETENERS

Cyclamate (Cyclosetas, Natreen, Respiroma, Neurodifioral)

– HIPOGLUCEMIANTES

Acetohexamide (Dymelor)
Chlorpropamide (Diabinese, Insulase, Clondiabet)
Tolazamide (Tolinase)
Tolbutamide (Orinase, Rastinon)
Carbutamide (Nadisan)

– HORMONAL • All hormonal drugs

– LAXANTS • Triacetyldiphenol

– PSORALENOS • Novo-melanidin

Lime essential oil (Bergamot)

– TETRACICLINES

Dermeclococline (Ledermycin)
Doxycycline (Vibrazine)
Minocycline (Minocin)
Tetracycline (Ambramicina, Becantal, Chemiciclina, Chimocyclar, Clor-miten, Cortihermes, Dynabiotal, Eritromiten, Finegosan, Laucalon, Neumobac, Tantumciclina)
Chlortetracycline (Agripine, Fluviatol) • Methacycline (Rodomycin)

What is recommended to avoid these reactions

In summary, we can recommend:

Identify the medications that can cause this reaction. The description can be found in pharmacological reviews, and in the technical data sheet of the medicine in the Spanish Agency of Medicines and Health Products. In the case of recently marketed active ingredients, it is possible to consult directly to drug information centers.
In the case of prescribing a photosensitizing medicine, the patient should be recommended a minimum exposure to solar radiation, especially during the summer. This limitation also includes exposure to artificial sources of UV radiation. Patients should be advised to wear suitable clothing, caps, sunglasses of proven optical quality. It should be remembered that shade can reduce direct UV radiation but not indirect radiation from nearby surfaces, such as snow, sand, water, or others. Topical sunscreens can complement the above recommendations, especially those with a broad spectrum, which protect against UV-A and UV-B radiation. Some of these protectors can also cause photosensitivity due to their content in: aminobenzoic acid, cinnamates and benzophenones. However,
It is recommended to administer those photosensitizing drugs at a daily dose at night. In this way, the concentration of the drug would be reduced in the moments of greatest exposure to sunlight.

What to do

It is recommended

Alert the patient to the type of reaction that may appear on the skin, and if it occurs, recommend immediate consultation with a healthcare professional. Any skin lesion that appears in areas exposed to sunlight requires an adequate anamnesis to confirm or rule out the possibility that they are iatrogenic-type reactions due to drugs, cosmetics or medicinal plants.
In the event of a reaction, administration of the medicinal product should be discontinued. However, in the case of chronic treatments in which it is not possible to suspend the medication, the option is to avoid exposure to natural and artificial sources of UV radiation.
Acute symptoms can be treated with cold wet compresses, topical corticosteroids (hydrocortisone, betamethasone, fluticasone) and, if necessary, with oral NSAIDs. In especially sensitive patients, administration of systemic corticosteroids may be necessary. Furthermore, oral antihistamines are also used in photoallergic reactions. Some of the drugs discussed and used as treatment may also be photosensitizers, so exposure to natural and artificial sources of UV radiation is absolutely contraindicated, especially during treatment.
It is recommended to report reactions of this type to the Pharmacovigilance System in order to increase the available evidence and epidemiological data.