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Drug-induced phototoxic reaction in Adult
Other Resources UpToDate PubMed

Drug-induced phototoxic reaction in Adult

Contributors: Susan Burgin MD, Michael D. Tharp MD, Neil Shear MD
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, topical tar.

Related topic: Drug-induced photosensitive reaction


L56.0 – Drug phototoxic response

83627000 – Phototoxic drug reaction

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Sunburn
  • Drug-induced photoallergic reaction
  • Systemic lupus erythematosus
  • Dermatomyositis
  • Porphyria cutanea tarda
  • Pseudoporphyria
  • Airborne Allergic contact dermatitis
  • Phytophotodermatitis
  • Widespread contact dermatitis (see Allergic contact dermatitis, Irritant contact dermatitis)
  • Lichen planus (if lichenoid papules are present)
  • Atopic dermatitis
  • Subacute cutaneous lupus erythematosus
  • 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.

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Last Reviewed:03/27/2018
Last Updated:04/19/2018
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Drug-induced phototoxic reaction in Adult
A medical illustration showing key findings of Drug-induced phototoxic reaction : Bullae, Burning skin sensation, Edema, Erythema, Photodistributed, Pruritus, Hives
Clinical image of Drug-induced phototoxic reaction - imageId=337847. Click to open in gallery.  caption: 'Deep red patches and plaques on the dorsal wrists, hands, and fingers, sparing the area under the wristwatch, secondary to a medication.'
Deep red patches and plaques on the dorsal wrists, hands, and fingers, sparing the area under the wristwatch, secondary to a medication.
Copyright © 2024 VisualDx®. All rights reserved.