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Jeong SH, Hong EH, Park EJ, Kim KJ, Kim KH. A Case of Pirfenidone-Induced Photosensitive Drug Eruption. Ann Dermatol 2023; 35:S48-S51. [PMID: 37853864 PMCID: PMC10608387 DOI: 10.5021/ad.21.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 10/20/2023] Open
Abstract
A 75-year-old male was diagnosed with idiopathic pulmonary fibrosis and treated with pirfenidone. He presented with an erythematous thick scaly patch on his face, neck, and both hands and arms. He had a history of significant exposure to sunlight without using sunscreen. All lesions were restricted to sun-exposed areas and appeared one month ago. Histopathological examination revealed necrotic keratinocytes, epidermal spongiosis, liquefaction degeneration of the basal layer, interface dermatitis, solar elastosis, and upper dermal perivascular lympho-histiocytic infiltration. Based on clinical and histopathological findings, the skin lesion could be diagnosed as photosensitive drug eruption induced by pirfenidone. Pirfenidone was discontinued for a month, and the patient was treated with oral and topical corticosteroids. Consequently, the skin lesion almost fully cleared, leaving mild postinflammatory hyperpigmentation. Although there are many reports of photosensitivity reactions to pirfenidone, dermatologists are still not familiar with this drug. Through this case presentation, clinicians should be aware of the potential phototoxic effects of pirfenidone and provide the necessary precautionary information to patients who take pirfenidone.
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Affiliation(s)
- Soo Hyun Jeong
- Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Eun Hye Hong
- Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Eun Joo Park
- Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kwang Joong Kim
- Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kwang Ho Kim
- Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea.
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Yoo SA, Park HE, Kim M, Park HJ. A Case Report of Pirfenidone-Induced Lichenoid Drug Eruption in a Patient with Idiopathic Pulmonary Fibrosis. Ann Dermatol 2022; 34:136-138. [PMID: 35450308 PMCID: PMC8989899 DOI: 10.5021/ad.2022.34.2.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/30/2020] [Accepted: 07/09/2020] [Indexed: 11/29/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, and lethal lung disease characterized by progressive dyspnea and irreversible loss of lung function. Pirfenidone is a novel anti-fibrotic and anti-inflammatory drug, which reduces deterioration in the lung function and prolongs progression-free survival in patients with IPF. However, it has adverse effects including gastrointestinal symptoms, hepatic dysfunction or skin photosensitivity, and rash. Lichenoid drug eruption (LDE) refers to lichen planus-like drug eruption usually presenting symmetric eczematous plaques with a purple hue. To date, numerous cases of LDE due to various drugs and pirfenidone-associated photosensitivity have been reported. However, a case of pirfenidone-induced LDE has been very rarely reported to our knowledge. Herein, is a case of pirfenidone-induced LDE so that clinicians can be aware of the possibility of LDE when using pirfenidone.
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Affiliation(s)
- Seung Ah Yoo
- Department of Dermatology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyo Eun Park
- Department of Dermatology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Miri Kim
- Department of Dermatology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Jeong Park
- Department of Dermatology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Wang C, He Y, Sun W, Wu C, Li Z, Sun L. Retrospective analysis of skin photosensitivity induced by pirfenidone. J Clin Pharm Ther 2021; 47:194-199. [PMID: 34655088 DOI: 10.1111/jcpt.13542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/07/2021] [Accepted: 10/08/2021] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Knowledge regarding the association between photosensitivity and pirfenidone is based mainly on case reports. The purpose of this article was to evaluate the clinical characteristics of photosensitivity associated with pirfenidone. METHODS We collected studies on photosensitivity induced by pirfenidone published from 2008 to 31 August 2021 in Chinese and English for a retrospective analysis. RESULTS AND DISCUSSION The median age was 70 years (range 57-80) in 22 patients with pirfenidone-induced photosensitivity. The dose at the onset of symptoms ranged from 600 to 2403 mg for the treatment of idiopathic pulmonary fibrosis. Pirfenidone-induced photosensitivity occurred within 1 week in some patients and up to 8 months in others. The most common clinical manifestation of photosensitivity caused by pirfenidone was itching on body parts exposed to sunlight (back of hands, face, neck, and limbs) in 15 patients followed by erythema in 13 patients. Histopathological examination revealed necrotic keratinocytes, lymphocytic inflammatory cell infiltrate, hyperkeratosis and liquefaction degeneration in 5 patients. The photosensitivity test showed a markedly decreased minimum erythema dose (MED) of 7-228 mJ/cm2 UV-B in 4 patients and 4.86-12 J/cm2 UV-A in 5 patients. The clinical symptoms were significantly improved or completely relieved with a median time of 4 weeks (range 1-8) after drug withdrawal, dose reduction or systemic and topical glucocorticoid therapy. WHAT IS NEW AND CONCLUSION Clinicians should be aware of the potential phototoxic effects of pirfenidone and should inform patients to take pirfenidone during (or after) a meal, avoid sun exposure, wear protective clothing, and apply broad-spectrum sunscreen with high ultraviolet UVA and UVB protection.
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Affiliation(s)
- Chunjiang Wang
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yang He
- Department of Pharmacy, The First Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Wei Sun
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Cuifang Wu
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Zuojun Li
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Linli Sun
- Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
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Choudhury S, Taweesedt PT, Dadhwal R, Surani S. Severe Photosensitivity Reaction After Pirfenidone Use. Cureus 2021; 13:e16626. [PMID: 34458037 PMCID: PMC8384726 DOI: 10.7759/cureus.16626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2021] [Indexed: 11/05/2022] Open
Abstract
Idiopathic pulmonary fibrosis is a chronic and progressive disease with a significant mortality rate. Pirfenidone is one of two oral antifibrotic therapies approved to treat idiopathic pulmonary fibrosis (IPF). Pirfenidone helps decrease disease progression in patients with IPF and reduces vital capacity. This has led to widespread use of this medication in recent years. In this case report, we present a 60-year-old male who started treatment with pirfenidone for IPF and had severe skin reactions after initiation of therapy.
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Affiliation(s)
- Saiara Choudhury
- Internal Medicine, Corpus Christi Medical Center, Corpus Christi, USA
| | | | - Rahul Dadhwal
- Pulmonary Medicine, Corpus Christi Medical Center, Corpus Christi, USA
| | - Salim Surani
- Anesthesiology, Mayo Clinic, Rochester, USA.,Medicine, Texas A&M University, College Station, USA.,Medicine, University of North Texas, Dallas, USA.,Internal Medicine, Pulmonary Associates, Corpus Christi, USA.,Clinical Medicine, University of Houston, Houston, USA
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Abstract
Many classes of drugs are known to cause a photosensitive reaction, including anti-bacterial, anti-inflammatory, and nonsteroidal drugs. Pirfenidone is an anti-inflammatory drug that is used to treat idiopathic pulmonary fibrosis (IPF). We report a case of a patient who developed a photosensitive rash secondary to pirfenidone use, which resolved after discontinuing administration of the drug.
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Affiliation(s)
| | - Sachin Vaidya
- Medicine, The Queen Elizabeth Hospital, Woodville South, AUS
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Morgado-Carrasco D, Massana J, Piquero-Casals J. Pirfenidone-induced phototoxic reaction. Int J Dermatol 2020; 60:e202-e203. [PMID: 33615459 DOI: 10.1111/ijd.15361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 11/26/2022]
Affiliation(s)
| | - Jaume Massana
- Dermatology Department, Hospital de Figueres Fundació Salut Empordà, Figueres, Spain
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Arunprasath P, Rai R, Venkataswamy C. Pirfenidone-Induced Dose-Dependent Phototoxicity - A Distinct Drug Reaction. Indian Dermatol Online J 2020; 11:1007-1009. [PMID: 33344360 PMCID: PMC7734975 DOI: 10.4103/idoj.idoj_40_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 05/31/2020] [Accepted: 06/24/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- P Arunprasath
- Department of Dermatology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Reena Rai
- Department of Dermatology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Chaitra Venkataswamy
- Department of Pathology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
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Macklis PC, Dulmage B, Evans B, Rosenbach M, Gudjonsson JE, Kaffenberger BH. Cutaneous Adverse Events in Newly Approved FDA Non-cancer Drugs: A Systematic Review. Drugs R D 2020; 20:171-187. [PMID: 32557274 PMCID: PMC7419407 DOI: 10.1007/s40268-020-00311-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The prevalence of cutaneous adverse events attributable to newly approved anti-cancer drugs has been well reviewed in the dermatologic literature. In contrast, over 75% of US Food and Drug Administration approvals in the past 5 years have been for non-cancer drugs and indications. This represents multiple other categories of approved medications associated with cutaneous adverse reactions. To investigate the cutaneous adverse events associated with these potentially neglected medications, a systematic review was conducted. Two hundred and forty-one medications approved by the Food and Drug Administration between 2013 and 2018 were reviewed and 180 non-oncologic drugs were identified. The prescribing information for each medication was reviewed for the presence of cutaneous adverse events and a supplemental literature search was performed to better characterize any adverse events outlined within the prescribing information. Most reactions were classified as morbilliform, macular, popular, or maculopapular. Fortunately, only a few severe cutaneous adverse reactions were reported, namely in benznidazole, cannabidiol, and sofosbuvir. This review summarizes available data drawn from clinical trials and case reports involving cutaneous adverse events from the 21 non-oncologic medications associated with cutaneous adverse events.
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Affiliation(s)
- Paul C Macklis
- Division of Dermatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, 2012 Kenny Road, Rm 232, Columbus, OH, 43212, USA
| | - Brittany Dulmage
- Division of Dermatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, 2012 Kenny Road, Rm 232, Columbus, OH, 43212, USA
| | - Brady Evans
- Division of Dermatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, 2012 Kenny Road, Rm 232, Columbus, OH, 43212, USA
| | - Misha Rosenbach
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Johann E Gudjonsson
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Benjamin H Kaffenberger
- Division of Dermatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, 2012 Kenny Road, Rm 232, Columbus, OH, 43212, USA.
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Muñoz-Aceituno E, Reolid A, Rodríguez-Jiménez P, Chicharro P, de Argila D. Photobiological study in pirfenidone-induced photosensitivity. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2020; 36:481-483. [PMID: 32516459 DOI: 10.1111/phpp.12582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/28/2020] [Accepted: 06/01/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Ester Muñoz-Aceituno
- Department of Dermatology. Hospital, Universitario de la Princesa, Madrid, Spain
| | - Alejandra Reolid
- Department of Dermatology. Hospital, Universitario de la Princesa, Madrid, Spain
| | | | - Pablo Chicharro
- Department of Dermatology. Hospital, Universitario de la Princesa, Madrid, Spain
| | - Diego de Argila
- Department of Dermatology. Hospital, Universitario de la Princesa, Madrid, Spain
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