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Hofmann GA, Weber B. Drug-induced photosensitivity: culprit drugs, potential mechanisms and clinical consequences. J Dtsch Dermatol Ges 2021; 19:19-29. [PMID: 33491908 PMCID: PMC7898394 DOI: 10.1111/ddg.14314] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/09/2020] [Indexed: 12/30/2022]
Abstract
Drug‐induced photosensitivity, the development of phototoxic or photoallergic reactions due to pharmaceuticals and subsequent exposure to ultraviolet or visible light, is an adverse effect of growing interest. This is illustrated by the broad spectrum of recent investigations on the topic, ranging from molecular mechanisms and culprit drugs through epidemiological as well as public health related issues to long‐term photoaging and potential photocarcinogenic consequences. The present review summarizes the current state of knowledge on the topic while focusing on culprit drugs and long‐term effects. In total, 393 different drugs or drug compounds are reported to have a photosensitizing potential, although the level of evidence regarding their ability to induce photosensitive reactions varies markedly among these agents. The pharmaceuticals of interest belong to a wide variety of drug classes. The epidemiological risk associated with the use of photosensitizers is difficult to assess due to under‐reporting and geographical differences. However, the widespread use of photosensitizing drugs combined with the potential photocarcinogenic effects reported for several agents has major implications for health and safety and suggests a need for further research on the long‐term effects.
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Affiliation(s)
- Georg Amun Hofmann
- Disease Modeling and Organoid Technology (DMOT) research group, Department of Dermatology, Medical University of Vienna, Austria
| | - Benedikt Weber
- Disease Modeling and Organoid Technology (DMOT) research group, Department of Dermatology, Medical University of Vienna, Austria
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Rok J, Rzepka Z, Respondek M, Beberok A, Wrześniok D. Chlortetracycline and melanin biopolymer - The risk of accumulation and implications for phototoxicity: An in vitro study on normal human melanocytes. Chem Biol Interact 2019; 303:27-34. [PMID: 30768968 DOI: 10.1016/j.cbi.2019.02.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/30/2019] [Accepted: 02/07/2019] [Indexed: 12/21/2022]
Abstract
Tetracyclines belong to antimicrobial classes with the highest consumption in veterinary medicine and agriculture, which leads to the contamination of the environment and food products, as well as to antibiotic resistance and adverse drug reactions. Chloro-derivatives of tetracyclines are thought to be relatively more phototoxic than others and belong to the most frequently cited drugs as photosensitizers. Melanins are heterogenous biopolymers determining skin, hair and eye colour. They are biosynthesized in a multistep process in melanocytes. Melanins, besides photoprotective and antioxidant properties, may also contribute to adverse skin drug reactions, which involve e.g. hyperpigmentation disorders and phototoxic reactions. Furthermore, they have the ability to form a drug-melanin complex, which leads to deposition of the drug or its metabolites in pigmented tissues. The aim of the study was to examine the ability of chlortetracycline to form a complex with melanin, as well as the effect of the drug on viability, antioxidant defence system and melanogenesis in normal human epidermal melanocytes exposed to the UVA radiation. The obtained results show for the first time that chlortetracycline forms a complex with melanin polymers, which creates a possibility of the drug accumulation in pigmented tissues. A simultaneous exposition of normal melanocytes to chlortetracycline and to the UVA radiation decreases cell viability, proportionally to the drug concentration and the irradiation time. The phototoxic effect appears to be related to the induction of oxidative stress in melanocytes, mainly through an increase of SOD and a decrease of the CAT activity. Chlortetracycline itself does not influence the melanin content or the activity of tyrosinase. The UVA radiation appeared to be a conditioning factor stimulating melanogenesis, whereas the presence of the drug augmented this effect.
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Affiliation(s)
- Jakub Rok
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Medical University of Silesia, Jagiellońska 4, PL 41-200, Sosnowiec, Poland.
| | - Zuzanna Rzepka
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Medical University of Silesia, Jagiellońska 4, PL 41-200, Sosnowiec, Poland
| | - Michalina Respondek
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Medical University of Silesia, Jagiellońska 4, PL 41-200, Sosnowiec, Poland
| | - Artur Beberok
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Medical University of Silesia, Jagiellońska 4, PL 41-200, Sosnowiec, Poland
| | - Dorota Wrześniok
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Medical University of Silesia, Jagiellońska 4, PL 41-200, Sosnowiec, Poland
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Lime-Induced Phytophotodermatitis. J Gen Intern Med 2018; 33:975. [PMID: 29380219 PMCID: PMC5975144 DOI: 10.1007/s11606-018-4315-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/25/2017] [Accepted: 01/11/2018] [Indexed: 10/18/2022]
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Abstract
Drug-induced photosensitivity reactions are significant adverse effects. Ketoprofen is one of the most common drugs that can cause skin rash in sun-exposed areas. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ketoprofen, are often used for a variety of symptoms, including pain and fever. An understanding of the presentation and clinical course of ketoprofen-induced photosensitivity is necessary to correctly diagnose and manage this condition. Ketoprofen-induced photosensitivity reactions usually present as photoallergic dermatitis, which is a cell-mediated immune process. The benzophenone moiety in ketoprofen plays a major role in ketoprofen's ability to act as a photosensitizer. Several agents, such as fenofibrate and octocrylene have been found to be associated with aggravation of ketoprofen-induced photoallergic dermatitis or cross-photosensitization, and these reactions result from structural similarities with ketoprofen. Treatment of ketoprofen-induced photoallergic dermatitis includes discontinuation of ketoprofen, topical or systemic corticosteroids and avoidance of sun exposure and agents known to exacerbate dermatitis. In conclusion, photoallergic dermatitis is a significant adverse effect of ketoprofen. Some agents known to worsen dermatitis may be found in sun protection products (notably, octocrylene in sunscreen). Educating the patient to avoid these products is critical to treatment. Since NSAIDs, such as ketoprofen, are used commonly for a variety of illnesses, drug-induced photoallergic dermatitis should be high on the differential in individuals using these medications who present with acute onset of a rash in sun-exposed areas.
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Affiliation(s)
- Tiffany Yvonne Loh
- School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Philip R Cohen
- Department of Dermatology, University of California San Diego, La Jolla, CA, USA
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Abstract
Many--topically applied or systemically administered--substances may trigger photoallergic skin reactions following exposure to ultraviolet (UV) radiation. While most cases represent photoallergic contact dermatitis due to topically applied agents, systemically triggered photoallergy is considerably less common. The photopatch test--a UV-exposed variant of the conventional patch test--is the mainstay in the diagnosis of photoallergic or phototoxic reactions.
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Affiliation(s)
- Anna Wilm
- Department of Dermatology, University of Regensburg, Germany
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Rok J, Buszman E, Beberok A, Delijewski M, Otręba M, Wrześniok D. Modulation of Melanogenesis and Antioxidant Status of Melanocytes in Response to Phototoxic Action of Doxycycline. Photochem Photobiol 2015; 91:1429-34. [PMID: 26189561 DOI: 10.1111/php.12497] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 07/01/2015] [Indexed: 11/29/2022]
Abstract
Doxycycline is a commonly used tetracycline antibiotic showing the broad spectrum of antibacterial action. However, the use of this antibiotic is often connected with the risk of phototoxic reactions that lead to various skin disorders. One of the factors influencing the photosensitivity reactions is the melanin content in melanocytes. In this study, the impact of doxycycline and UVA irradiation on cell viability, melanogenesis and antioxidant defense system in cultured normal human epidermal melanocytes (HEMn-DP) was examined. The exposure of cells to doxycycline and UVA radiation resulted in concentration-dependent loss in melanocytes viability and induced melanin biosynthesis. Significant changes were stated in cellular antioxidant enzymes activity: SOD, CAT and GPx, which indicates alterations of antioxidant defense system. The results obtained in vitro may explain the mechanisms of phototoxic reactions that occur in normal human epidermal melanocytes in vivo after exposure of skin to doxycycline and UVA radiation.
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Affiliation(s)
- Jakub Rok
- Chair and Department of Pharmaceutical Chemistry, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia, Sosnowiec, Poland
| | - Ewa Buszman
- Chair and Department of Pharmaceutical Chemistry, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia, Sosnowiec, Poland
| | - Artur Beberok
- Chair and Department of Pharmaceutical Chemistry, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia, Sosnowiec, Poland
| | - Marcin Delijewski
- Chair and Department of Pharmaceutical Chemistry, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia, Sosnowiec, Poland
| | - Michał Otręba
- Chair and Department of Pharmaceutical Chemistry, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia, Sosnowiec, Poland
| | - Dorota Wrześniok
- Chair and Department of Pharmaceutical Chemistry, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia, Sosnowiec, Poland
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Pant S, Keyes LE, Sharma R, Basnyat B. A trekker in Nepal with painful skin blisters. BMJ Case Rep 2015; 2015:bcr-2015-210560. [PMID: 26088533 DOI: 10.1136/bcr-2015-210560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The authors present a case of a 27-year-old woman trekker with painful, slightly itchy eruptions on the dorsum of both hands for 5 days. On examination, she had a papulovesicular rash with some haemorrhagic vesicles over the dorsum of her hands and thumbs.
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Affiliation(s)
- Sushil Pant
- Mountain Medicine Society of Nepal, Kathmandu, Nepal Kunde Hospital, Khumjung, Solukhumbu, Nepal
| | - Linda E Keyes
- Department of Emergency Medicine, University of Colorado, Boulder, Colorado, USA
| | - Ramesh Sharma
- Department of Dermatology and Venereal Diseases, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Buddha Basnyat
- Clinical Research Unit, Oxford University, Patan Hospital, Kathmandu, Nepal
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Rok J, Buszman E, Delijewski M, Otręba M, Beberok A, Wrześniok D. Effect of tetracycline and UV radiation on melanization and antioxidant status of melanocytes. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2015; 148:168-173. [PMID: 25935746 DOI: 10.1016/j.jphotobiol.2015.04.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 04/13/2015] [Accepted: 04/20/2015] [Indexed: 11/28/2022]
Abstract
Tetracycline is a semisynthetic antibiotic and is used in several types of infections against both gram-positive and gram-negative bacteria. This therapy is often associated with phototoxic reactions that occur after exposure to UV radiation and lead to photo-onycholysis, pseudoporphyria, solar urticaria and the fixed drug eruption in the skin. The phototoxic reactions may be related to the melanin content which, on one side may bind drugs - leading to their accumulation, and on the other side, they have photoprotective and antioxidant properties. In this study the effect of tetracycline and UVA irradiation on cell viability, biosynthesis of melanin and antioxidant defense system in cultured normal human epidermal melanocytes (HEMn-DP) was analyzed. The viability of the cells treated with tetracycline and exposed to UVA radiation decreased in a drug concentration-dependent manner. At the same time, the induction of the melanization process was observed. The significant alterations in antioxidant defense system, on the basis of changes in SOD, CAT and GPx activities, were stated. The obtained results may give explanation for the phototoxic effects of tetracycline therapy observed in skin cells exposed to UVA radiation.
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Affiliation(s)
- Jakub Rok
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Medical University of Silesia, Jagiellońska 4, PL 41-200 Sosnowiec, Poland
| | - Ewa Buszman
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Medical University of Silesia, Jagiellońska 4, PL 41-200 Sosnowiec, Poland.
| | - Marcin Delijewski
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Medical University of Silesia, Jagiellońska 4, PL 41-200 Sosnowiec, Poland
| | - Michał Otręba
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Medical University of Silesia, Jagiellońska 4, PL 41-200 Sosnowiec, Poland
| | - Artur Beberok
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Medical University of Silesia, Jagiellońska 4, PL 41-200 Sosnowiec, Poland
| | - Dorota Wrześniok
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Medical University of Silesia, Jagiellońska 4, PL 41-200 Sosnowiec, Poland
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Affiliation(s)
- Anna Wilm
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg
| | - Mark Berneburg
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg
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Tabner A, McQueen C, Hewitt S. Summertime and the patient is itchy. BMJ Case Rep 2014; 2014:bcr-2014-206746. [PMID: 25410034 DOI: 10.1136/bcr-2014-206746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 21-year-old man presented to the emergency department with a 36 h history of a painful, itchy maculopapular rash and associated vesicles to his arms and neck. He had no history of exposure to new chemicals or hygiene products and no significant medical history. His physiological observations were normal and systemic examination was unremarkable. On close inspection the rash was noted to be present only on areas of skin exposed while wearing a polo shirt. On further questioning it transpired that he had been gardening 12 h prior to the development of the rash. A diagnosis of phytophotodermatitis was made. The patient was discharged with chlorphenamine, simple analgesia and the advice to wear a long-sleeved t-shirt and sunscreen when gardening in future. Phytophotodermatitis is a cutaneous reaction caused by contact with light-sensitising compounds found in plants and exposure to ultraviolet A radiation. It is self-limiting and can be managed symptomatically.
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Affiliation(s)
- Andrew Tabner
- Emergency Department, Royal Derby Hospital, Derby, UK
| | - Carl McQueen
- Emergency Department, Royal Derby Hospital, Derby, UK University of Warwick, Coventry, UK
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Sieber MA, Hegel JKE. Azelaic acid: Properties and mode of action. Skin Pharmacol Physiol 2013; 27 Suppl 1:9-17. [PMID: 24280644 DOI: 10.1159/000354888] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Acne is a common skin disorder that can be problematic for adults as well as for adolescents. It has several key pathophysiological features such as follicular hyperkeratosis, elevated Propionibacterium acnes proliferation, and reactive inflammation, all of which should be targeted for an optimal outcome. Azelaic acid (AzA) has profound anti-inflammatory, antioxidative effects, and is bactericidal against a range of Gram-negative and Gram-positive microorganisms as well, including antibiotic-resistant bacterial strains. In addition, AzA's antikeratinizing effects are inhibitory toward comedones. AzA is effective overall in targeting multiple causes of acne and has been proven to be well tolerated in numerous clinical trials.
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Affiliation(s)
- M A Sieber
- Global Medical Affairs Dermatology, Bayer Pharma AG, Berlin, Germany
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Establishment of an in vitro photoassay using THP-1 cells and IL-8 to discriminate photoirritants from photoallergens. Toxicol In Vitro 2013; 27:1920-7. [DOI: 10.1016/j.tiv.2013.06.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 06/07/2013] [Accepted: 06/24/2013] [Indexed: 11/22/2022]
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Siiskonen SJ, Koomen ER, Visser LE, Herings RMC, Guchelaar HJ, Stricker BHC, Nijsten TEC. Exposure to phototoxic NSAIDs and quinolones is associated with an increased risk of melanoma. Eur J Clin Pharmacol 2013; 69:1437-44. [PMID: 23471440 DOI: 10.1007/s00228-013-1476-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 01/27/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE Ultraviolet radiation exposure is the most important exogenous risk factor for cutaneous malignancies. It is possible that phototoxic drugs promote the development of cutaneous melanoma (CM) by intensifying the effect of ultraviolet light on the skin. We investigated the association between the use of common systemic phototoxic drugs and development of CM. METHODS This study was a case-control study in a Dutch population-based cohort. The drug dispensing data was obtained from PHARMO, a Dutch drug dispensing and hospital admissions registry, and linked to PALGA, the nationwide pathology network of the Netherlands. The cases were patients diagnosed with pathologically confirmed primary CM between 1991 and 2004. Controls were sampled from the PHARMO population. Exposure to systemic phototoxic drugs was measured and included antimicrobial agents, diuretics, antipsychotic drugs, antidiabetic drugs, cardiac drugs, antimalarials and nonsteroidal anti-inflammatory drugs (NSAIDs). A multivariate conditional logistic regression analysis was performed to study the association between exposure to phototoxic drugs and CM. RESULTS The study population included 1,318 cases and 6,786 controls. Any phototoxic drug during the study period was dispensed for 46 % of the cases and 43 % of the controls (p = 0.012). The use of quinolones [odds ratio (OR) 1.33, 95 % confidence interval (CI) 1.01-1.76] and propionic acid derivative NSAIDs (OR 1.33, 95 % CI 1.14-1.54) had a positive association with CM. CONCLUSIONS Our study shows that the use of phototoxic drugs is associated with an increased risk of developing CM. Even a short-term use of phototoxic quinolones and propionic acid derivative NSAIDs may increase the risk for CM. Patient education to promote sun-protective behaviour is essential to avoid immediate adverse effects and possible long-term effects of phototoxic drugs.
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Affiliation(s)
- Satu J Siiskonen
- Department of Dermatology, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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Friedman GD, Asgari MM, Warton EM, Chan J, Habel LA. Antihypertensive drugs and lip cancer in non-Hispanic whites. ARCHIVES OF INTERNAL MEDICINE 2012; 172:1246-51. [PMID: 22869299 PMCID: PMC3809130 DOI: 10.1001/archinternmed.2012.2754] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND In screening pharmaceuticals for possible carcinogenic effects we noted an association between lip cancer risk and the photosensitizing antihypertensive drugs hydrochlorothiazide and nifedipine. In this study, we further characterized the risk of lip cancer associated with these and other commonly used antihypertensive drugs. METHODS In a comprehensive medical care program, we evaluated prescriptions dispensed and cancer occurrence from August 1, 1994, to February 29, 2008. We identified 712 patients with lip cancer (cases) and 22,904 comparison individuals (controls) matched for age, sex, and cohort year of entry in the susceptible group, non-Hispanic whites. We determined use, at least 2 years before diagnosis or control index date, of the commonly prescribed diuretics hydrochlorothiazide and hydrochlorothiazide combined with triamterene, the angiotensin-converting enzyme inhibitor lisinopril, the calcium channel blocker nifedipine, and the β-adrenergic blocker atenolol, the only nonphotosensitizer agent studied. We analyzed the use of each drug exclusively and regardless of use of the others, and focused on duration of use. Conditional logistic regression was used for analysis of matched case-control sets, with control for cigarette smoking. RESULTS At least a 5-year supply of a drug yielded the following odds ratios (95% CIs), respectively, compared with no use: hydrochlorothiazide, 4.22 (2.82-6.31); hydrochlorothiazide-triamterene, 2.82 (1.74-4.55); lisinopril, 1.42 (0.95-2.13); nifedipine, 2.50 (1.29-4.84); and atenolol, 1.93 (1.29-2.91). When the other drugs were excluded, the odds ratio for atenolol was reduced to 0.54 (0.07-4.08). CONCLUSION These data support an increased risk of lip cancer in non-Hispanic whites receiving treatment for hypertension with long-term use of photosensitizing drugs.
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Affiliation(s)
- Gary D Friedman
- Division of Research, Kaiser Permanente Medical Care Program, Oakland, California, USA
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Quaak MSW, Martens H, Hassing RJ, van Beek-Nieuwland Y, van Genderen PJJ. The sunny side of lime. J Travel Med 2012; 19:327-8. [PMID: 22943277 DOI: 10.1111/j.1708-8305.2012.00644.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Revised: 06/16/2012] [Accepted: 06/25/2012] [Indexed: 11/29/2022]
Abstract
A 26-year-old woman was affected with a maculopapular rash because of a jellyfish sting on her right leg while surfing in Indonesia. A locally-prepared liniment was applied on the affected skin. She presented with hyperpigmented linear tracks that she noted a few days later.
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Affiliation(s)
- Marjolijn S W Quaak
- Department of Internal Medicine, Harbor Hospital and Institute for Tropical Diseases, Rotterdam, South Holland, The Netherlands
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Reus AA, Usta M, Kenny JD, Clements PJ, Pruimboom-Brees I, Aylott M, Lynch AM, Krul CA. The in vivo rat skin photomicronucleus assay: phototoxicity and photogenotoxicity evaluation of six fluoroquinolones. Mutagenesis 2012; 27:721-9. [DOI: 10.1093/mutage/ges038] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Adverse effects of antimicrobials via predictable or idiosyncratic inhibition of host mitochondrial components. Antimicrob Agents Chemother 2012; 56:4046-51. [PMID: 22615289 DOI: 10.1128/aac.00678-12] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
This minireview explores mitochondria as a site for antibiotic-host interactions that lead to pathophysiologic responses manifested as nonantibacterial side effects. Mitochondrion-based side effects are possibly related to the notion that these organelles are archaic bacterial ancestors or commandeered remnants that have co-evolved in eukaryotic cells; thus, this minireview focuses on mitochondrial damage that may be analogous to the antibacterial effects of the drugs. Special attention is devoted to aminoglycosides, chloramphenicol, and fluoroquinolones and their respective single side effects related to mitochondrial disturbances. Linezolid/oxazolidinone multisystemic toxicity is also discussed. Aminoglycosides and oxazolidinones are inhibitors of bacterial ribosomes, and some of their side effects appear to be based on direct inhibition of mitochondrial ribosomes. Chloramphenicol and fluoroquinolones target bacterial ribosomes and gyrases/topoisomerases, respectively, both of which are present in mitochondria. However, the side effects of chloramphenicol and the fluoroquinolones appear to be based on idiosyncratic damage to host mitochondria. Nonetheless, it appears that mitochondrion-associated side effects are a potential aspect of antibiotics whose targets are shared by prokaryotes and mitochondria-an important consideration for future drug design.
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Hofbauer GFL, Attard NR, Harwood CA, McGregor JM, Dziunycz P, Iotzova-Weiss G, Straub G, Meyer R, Kamenisch Y, Berneburg M, French LE, Wüthrich RP, Karran P, Serra AL. Reversal of UVA skin photosensitivity and DNA damage in kidney transplant recipients by replacing azathioprine. Am J Transplant 2012; 12:218-25. [PMID: 21943390 DOI: 10.1111/j.1600-6143.2011.03751.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Azathioprine is associated with enhanced skin photosensitivity to ultraviolet A (UVA) and leads to incorporation of 6-thioguanine (6-TG) into DNA of dividing cells. Unlike canonical DNA, 6-TG DNA is damaged by UVA, which comprises more than 90% of the ultraviolet reaching earth. Skin photosensitivity to UVA and UVB was measured in 48 kidney transplant patients immunosuppressed either by azathioprine (n = 32) or mycophenolate (n = 16). In 23 patients, azathioprine was subsequently replaced by mycophenolate and skin photosensitivity, DNA 6-TG content in peripheral blood mononuclear cells, and susceptibility to UVA-induced DNA damage were monitored for up to 2 years. The mean minimal erythema dose to UVA on azathioprine was twofold lower than on mycophenolate. Three months after replacing azathioprine by mycophenolate mofetil, the minimal erythema dose to UVA had increased from 15 to 25 J/cm(2) (p < 0.001) accompanied by reduced DNA 6-TG content. P53 protein expression in irradiated skin indicated reduced susceptibility to UVA-induced DNA damage. 6-TG DNA in peripheral blood mononuclear cells remained measurable for over 2 years. Replacing azathioprine selectively reduced the skin photosensitivity to UVA, attenuated UVA-induced skin DNA damage, and is likely based on incorporated 6-TG in DNA.
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Affiliation(s)
- G F L Hofbauer
- Department of Dermatology, University Hospital Zürich, Switzerland.
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Son YM, Roh JY, Cho EK, Lee JR. Photosensitivity reactions to vandetanib: redevelopment after sequential treatment with docetaxel. Ann Dermatol 2011; 23:S314-8. [PMID: 22346266 PMCID: PMC3276785 DOI: 10.5021/ad.2011.23.s3.s314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Revised: 01/11/2011] [Accepted: 01/21/2011] [Indexed: 11/08/2022] Open
Abstract
Vandetanib (ZD6474, Zactima™) is a novel, orally available inhibitor of different intracellular signaling pathways involved in tumor growth, progression, and angiogenesis, including vascular endothelial growth factor receptor-2, epidermal growth factor receptor, and rearranged during transfection tyrosine kinase activity. The most frequently reported adverse events attributed to vandetanib include diarrhea, elevated aminotransferase, asymptomatic corrected QC interval prolongation, and hypertension. In a few randomized, double-blinded studies, cutaneous adverse events including these general symptoms have been reported, but there are only a few reports on the photosensitivity reaction to vandetanib domestically as conducted by dermatologists. In this report, we describe two cases of photosensitivity reactions induced by vandetanib. After improvement with steroid and antihistamine, the photosensitivity reaction was redeveloped by sequential treatment with docetaxel.
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Affiliation(s)
- Young-Min Son
- Department of Dermatology, Gachon University of Medicine and Science, Gil Hospital, Incheon, Korea
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Update on Photodermatoses. ACTA ACUST UNITED AC 2011; 30:229-38. [DOI: 10.1016/j.sder.2011.07.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 07/27/2011] [Accepted: 07/27/2011] [Indexed: 11/22/2022]
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Epaulard O, Leccia MT, Blanche S, Chosidow O, Mamzer-Bruneel MF, Ravaud P, Thiebaut A, Villier C, Lortholary O. Phototoxicity and photocarcinogenesis associated with voriconazole. Med Mal Infect 2011; 41:639-45. [PMID: 22055586 DOI: 10.1016/j.medmal.2011.09.016] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 08/03/2011] [Accepted: 09/23/2011] [Indexed: 11/15/2022]
Abstract
The antifungal voriconazole was given its marketing authorization in 2002. Several kinds of adverse effects have been reported, including acute and chronic cutaneous adverse effects, mainly due to a phototoxicity mechanism. More recently, some authors have reported that voriconazole was involved in the occurrence of multiple and often-aggressive cutaneous squamous cell carcinomas if the treatment was maintained for a long time. According to safety data in studies assessing voriconazole effectiveness, 8% of outpatients may experience phototoxic events. An overview of the different types of phototoxicity and of the concerned population was given by the 61 published case reports of photo-induced voriconazole-related skin adverse events (including 18 cases of squamous cell carcinomas). The most likely mechanisms may be phototoxicity directly related to either voriconazole or to its N-oxide main metabolite, and an interaction with retinoid metabolism; moreover, immunodeficiency may enhance the risk of skin cancer. Several issues remain to be investigated, and studies are needed concerning the phototoxicity and photocarcinogenesis of voriconazole and the prognosis of chronic non-malignant skin lesions. Voriconazole prescription must be associated with strict photoprotection; in case of a phototoxic adverse event, another azole may be recommended.
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Affiliation(s)
- O Epaulard
- Service des maladies infectieuses et de médecine tropicale, CHU de Grenoble, France.
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Camp WL, Turnham JW, Athar M, Elmets CA. New agents for prevention of ultraviolet-induced nonmelanoma skin cancer. ACTA ACUST UNITED AC 2011; 30:6-13. [PMID: 21540016 DOI: 10.1016/j.sder.2011.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
With the incidence of nonmelanoma skin cancer on the rise, current prevention methods, such as the use of sunscreens, have yet to prove adequate to reverse this trend. There has been considerable interest in identifying compounds that will inhibit or reverse the biochemical changes required for skin cancers to develop, either by pharmacologic intervention or by dietary manipulation. By targeting different pathways identified as important in the pathogenesis of nonmelanoma skin cancers, a combination approach with multiple agents or the addition of chemopreventative agents to topical sunscreens may offer the potential for novel and synergistic therapies in treating nonmelanoma skin cancer.
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Affiliation(s)
- William L Camp
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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Discovery of MK-7246, a selective CRTH2 antagonist for the treatment of respiratory diseases. Bioorg Med Chem Lett 2011; 21:288-93. [DOI: 10.1016/j.bmcl.2010.11.015] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 10/27/2010] [Accepted: 11/01/2010] [Indexed: 01/22/2023]
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25
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High-ceiling diuretics are associated with an increased risk of basal cell carcinoma in a population-based follow-up study. Eur J Cancer 2010; 46:2467-72. [DOI: 10.1016/j.ejca.2010.04.024] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 04/28/2010] [Indexed: 01/19/2023]
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Development and characterization of an in vivo skin photomicronucleus assay in rats. Mutagenesis 2010; 25:407-16. [DOI: 10.1093/mutage/geq023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Couteau C, El-Boury S, Paparis E, Sébille-Rivain V, Coiffard LJM. In vitro UV-A protection factor (PF-UVA) of organic and inorganic sunscreens. Pharm Dev Technol 2009; 14:369-72. [DOI: 10.1080/10837450802683966] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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28
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Abstract
Drug-induced photosensitivity involves reactions to medication triggered by exposure of the skin to ultraviolet light. Medications that trigger reactions can be topical or oral. Following interaction of ultraviolet radiation with a chemical present in sufficient amounts in the skin, one of the several reactions may occur in susceptible patients, most commonly photoallergy or phototoxicity. These reactions can be diagnosed separately based on pathogenesis, clinical characteristics and histopathology. Phototoxic disorders have a higher incidence than photoallergic disorders. The action spectra for most photoallergens and phototoxins lie in the ultraviolet A range. Subtypes of drug-induced photosensitivity include dyschromia, pseudoporphyria, photo onycholysis, and lichenoid and telangiectatic reactions.
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Affiliation(s)
- Kevin R Stein
- New York Medical College, Department of Dermatology, Metropolitan Hospital Center, New York, NY 10029, USA
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