1
|
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.
Collapse
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
| |
Collapse
|
2
|
Lozzi F, Di Raimondo C, Lanna C, Diluvio L, Mazzilli S, Garofalo V, Dika E, Dellambra E, Coniglione F, Bianchi L, Campione E. Latest Evidence Regarding the Effects of Photosensitive Drugs on the Skin: Pathogenetic Mechanisms and Clinical Manifestations. Pharmaceutics 2020; 12:E1104. [PMID: 33213076 PMCID: PMC7698592 DOI: 10.3390/pharmaceutics12111104] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 10/29/2020] [Accepted: 11/02/2020] [Indexed: 12/27/2022] Open
Abstract
Photosensitivity induced by drugs is a widely experienced problem, concerning both molecule design and clinical practice. Indeed, photo-induced cutaneous eruptions represent one of the most common drug adverse events and are frequently an important issue to consider in the therapeutic management of patients. Phototoxicity and photoallergy are the two different pathogenic mechanisms involved in photosensitization. Related cutaneous manifestations are heterogeneous, depending on the culprit drug and subject susceptibility. Here we report an updated review of the literature with respect to pathogenic mechanisms of photosensitivity, clinical manifestations, patient management, and prediction and evaluation of drug-induced photosensitivity. We present and discuss principal groups of photosensitizing drugs (antimicrobials, nonsteroidal anti-inflammatory drugs, anti-hypertensives, anti-arrhythmics, cholesterol, and glycemia-lowering agents, psychotropic drugs, chemotherapeutics, etc.) and their main damage mechanisms according to recent evidence. The link between the drug and the cutaneous manifestation is not always clear; more investigations would be helpful to better predict drug photosensitizing potential, prevent and manage cutaneous adverse events and find the most appropriate alternative therapeutic strategy.
Collapse
Affiliation(s)
- Flavia Lozzi
- Dermatology Unit, Department of Internal Medicine, Tor Vergata University, 00133 Rome, Italy; (F.L.); (C.D.R.); (C.L.); (L.D.); (S.M.); (V.G.)
| | - Cosimo Di Raimondo
- Dermatology Unit, Department of Internal Medicine, Tor Vergata University, 00133 Rome, Italy; (F.L.); (C.D.R.); (C.L.); (L.D.); (S.M.); (V.G.)
| | - Caterina Lanna
- Dermatology Unit, Department of Internal Medicine, Tor Vergata University, 00133 Rome, Italy; (F.L.); (C.D.R.); (C.L.); (L.D.); (S.M.); (V.G.)
| | - Laura Diluvio
- Dermatology Unit, Department of Internal Medicine, Tor Vergata University, 00133 Rome, Italy; (F.L.); (C.D.R.); (C.L.); (L.D.); (S.M.); (V.G.)
| | - Sara Mazzilli
- Dermatology Unit, Department of Internal Medicine, Tor Vergata University, 00133 Rome, Italy; (F.L.); (C.D.R.); (C.L.); (L.D.); (S.M.); (V.G.)
| | - Virginia Garofalo
- Dermatology Unit, Department of Internal Medicine, Tor Vergata University, 00133 Rome, Italy; (F.L.); (C.D.R.); (C.L.); (L.D.); (S.M.); (V.G.)
| | - Emi Dika
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Via Massarenti, 1-40138 Bologna, Italy;
| | - Elena Dellambra
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell’Immacolata–Istituto di Ricovero e Cura a Carattere Scientifico (IDI-IRCCS), via dei Monti di Creta 104, 00167 Rome, Italy;
| | - Filadelfo Coniglione
- Department of Clinical Science and Translational Medicine, Tor Vergata University, 00133 Rome, Italy;
| | - Luca Bianchi
- Dermatology Unit, Department of Internal Medicine, Tor Vergata University, 00133 Rome, Italy; (F.L.); (C.D.R.); (C.L.); (L.D.); (S.M.); (V.G.)
| | - Elena Campione
- Dermatology Unit, Department of Internal Medicine, Tor Vergata University, 00133 Rome, Italy; (F.L.); (C.D.R.); (C.L.); (L.D.); (S.M.); (V.G.)
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|