Drug-induced photosensitive reaction
See also in: External and Internal EyeAlerts and Notices
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
Look For
Subscription Required
Diagnostic Pearls
Subscription Required
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
Best Tests
Subscription Required
Management Pearls
Subscription Required
Therapy
Subscription Required
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
Subscription Required
Last Reviewed:03/28/2018
Last Updated:06/06/2018
Last Updated:06/06/2018
Patient Information for Drug-induced photosensitive reaction
Premium Feature
VisualDx Patient Handouts
Available in the Elite package
- Improve treatment compliance
- Reduce after-hours questions
- Increase patient engagement and satisfaction
- Written in clear, easy-to-understand language. No confusing jargon.
- Available in English and Spanish
- Print out or email directly to your patient
Upgrade Today
Drug-induced photosensitive reaction
See also in: External and Internal Eye