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Drug-induced photosensitive reaction
See also in: External and Internal Eye
Other Resources UpToDate PubMed

Drug-induced photosensitive reaction

See also in: External and Internal Eye
Contributors: Susan Burgin MD, Lowell A. Goldsmith MD, MPH
Other Resources UpToDate PubMed


Drug-induced photosensitivity can be divided into 2 kinds of reactions: phototoxic and photoallergic.

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.
Phototoxic drug reactions are predictable and dose related in the sense that all patients exposed to enough drugs and enough UV exposure will develop phototoxicity. Some of the more common offenders include the following: antiarrhythmics (amiodarone, quinidine), antifungals (voriconazole), diuretics (furosemide, thiazides), NSAIDs (nabumetone, naproxen, piroxicam), phenothiazines (chlorpromazine, prochlorperazine), psoralens (5-methoxypsoralen, 8-methoxypsoralen), quinolones (ciprofloxacin, lomefloxacin, nalidixic acid, sparfloxacin), tetracyclines (doxycycline, demeclocycline), vemurafenib, St. John's wort, and topical tar.

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.


L56.8 – Other specified acute skin changes due to ultraviolet radiation

69047008 – Drug-induced photosensitivity

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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.

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Last Reviewed:03/28/2018
Last Updated:06/06/2018
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Patient Information for Drug-induced photosensitive reaction
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Contributors: Medical staff writer


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.


Topical corticosteroids in cream or ointment form can reduce itching.

For severe rashes, your doctor may prescribe a corticosteroid like prednisone to reduce inflammation.
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Drug-induced photosensitive reaction
See also in: External and Internal Eye
A medical illustration showing key findings of Drug-induced photosensitive reaction : Rash, Erythema, Photosensitivity, Photodistributed
Clinical image of Drug-induced photosensitive reaction - imageId=220003. Click to open in gallery.  caption: 'Scaly and crusted erythematous plaques on the photoexposed aspects of the forearms and hands.'
Scaly and crusted erythematous plaques on the photoexposed aspects of the forearms and hands.
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