Drug-induced photosensitive reaction
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Synopsis
Drug-induced phototoxicity results in a rash similar to sunburn. The rash is thought to result from a systemic drug (circulating in superficial dermal blood vessels) absorbing ultraviolet light (UVL) and releasing free radicals and reactive oxygen species, which damage or "burn" the skin in only those areas exposed to the UV source. All drugs that cause such a reaction absorb UV and/or visible radiation. The effects are dependent on both the dose of the drug and the amount of UVL that the person is exposed to.
In general, patients with a phototoxic drug eruption complain of burning.
Three types of clinical reactions can occur:
- Immediate / Mild – Immediate onset of erythema occurring approximately 30 minutes after UVL exposure. This reaction is associated with burning and pruritus but minimal edema. It usually lasts for 1-2 days after stopping UVL exposure.
- Immediate / Wheals – Immediate onset of transient wheals associated with burning. This reaction can occur with room light (non-UVL) and resolves rapidly after light exposure is stopped.
- Delayed / Severe – Onset is 8-24 hours after UVL exposure. This reaction is associated with dark erythema, edema, and hyperpigmentation. Blistering may occur with severe reactions. It usually lasts 2-4 days after UVL exposure is stopped, but in some instances, it may persist for months.
Drug-induced photoallergic reactions are allergic reactions due to UVL- induced alteration of a drug. They are dose independent and do not occur in all patients. Patients typically complain of itching rather than burning, and symptoms tend to be chronic. Common offenders include the following: sunscreens (oxybenzone [benzophenones, cinnamates-3]), fragrances (musk ambrette, sandalwood oil), topical antimicrobial agents (chlorhexidine, fenticlor, hexachlorophene), NSAIDs (diclofenac, ketoprofen, piroxicam, celecoxib), phenothiazines (chlorpromazine, promethazine), antiarrhythmics (quinidine), antifungals (griseofulvin), antimalarials (quinine), quinolones (enoxacin, lomefloxacin), sulphonylureas (glipizide), and sulfonamides.
Drug-induced photoallergic reactions manifest as red, scaling, pruritic (eczematous) papules and plaques in photodistributed areas (forehead, malar areas, sides of neck, and dorsum of the hands). This eruption is often pruritic and looks like chronic atopic dermatitis with a photodistribution.
Codes
ICD10CM:L56.8 – Other specified acute skin changes due to ultraviolet radiation
SNOMEDCT:
69047008 – Drug-induced photosensitivity
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Differential Diagnosis & Pitfalls
- Sunburn
- Systemic lupus erythematosus
- Dermatomyositis
- Porphyria cutanea tarda
- Pseudoporphyria
- Airborne contact dermatitis
- Phytophotodermatitis
- Widespread contact dermatitis (allergic, irritant)
- Lichen planus (if lichenoid papules are present)
- Atopic dermatitis
- Chronic actinic dermatitis
- Subacute cutaneous lupus
- Pemphigus foliaceus
- Pellagra
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:03/28/2018
Last Updated:06/06/2018
Last Updated:06/06/2018
Patient Information for Drug-induced photosensitive reaction
Overview
There are medications that make some people's skin more sensitive to sunlight. The ultraviolet (UV) light in sunlight can interact with drugs that circulate through your entire body. The reactions vary from a sunburn-like rash to itching. Rashes can be mild or severe with blisters.Drugs that cause a red, burning rash include antifungal medications, naproxen (Aleve), heart rhythm medications, diuretics used to treat hypertension, some antipsychotic medications (phenothiazine), some antibiotics, and St. John's wort.
Drugs that cause an itching reaction include certain topical (cream or ointment) antibiotics, some oral antibiotics, diclofenac, ketoprofen, piroxicam, antifungal medications, heart rhythm medications, diuretics used to treat hypertension, some antipsychotic medications (phenothiazine), and antimalarial medications.
Some fragrances and sunscreens can also cause an allergic, itching-type reaction to UV light.
Who’s At Risk
Anyone who takes a large enough dose of a drug known to cause reactions to sunlight can expect a reaction with enough sun exposure.Signs & Symptoms
If the drug causes a sunburn-type rash, skin exposed to the sun will turn red. It will burn and sting. If the reaction is severe, the rash may blister or swell. A mild rash will appear 30 minutes after exposing your skin to sunlight. More severe rashes can appear right away. The reaction usually lasts 2-4 days.If the drug causes an itching rash, skin exposed to the sun may have a flat, red, patchy rash. This type of rash can spread to skin that has not been exposed to the sun.
Self-Care Guidelines
Protect yourself from UV light. Limit your time in direct sunlight, and use sunscreen. The best sunscreens for preventing reactions have both UVA and UVB protection.To ease burning and stinging, take an over-the-counter pain reliever like Advil and rest cool washcloths on the rash.
When to Seek Medical Care
If you think your medication is causing a reaction, talk to your health care provider about possible alternatives.Treatments
Topical corticosteroids in cream or ointment form can reduce itching.For severe rashes, your doctor may prescribe a corticosteroid like prednisone to reduce inflammation.
Drug-induced photosensitive reaction
See also in: External and Internal Eye