1
|
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
|
2
|
Blakely KM, Drucker AM, Rosen CF. Drug-Induced Photosensitivity-An Update: Culprit Drugs, Prevention and Management. Drug Saf 2020; 42:827-847. [PMID: 30888626 DOI: 10.1007/s40264-019-00806-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Photosensitive drug eruptions are cutaneous adverse events due to exposure to a medication and either ultraviolet or visible radiation. In this review, the diagnosis, prevention and management of drug-induced photosensitivity is discussed. Diagnosis is based largely on the history of drug intake and the appearance of the eruption primarily affecting sun-exposed areas of the skin. This diagnosis can also be aided by tools such as phototesting, photopatch testing and rechallenge testing. The mainstay of management is prevention, including informing patients of the possibility of increased photosensitivity as well as the use of appropriate sun protective measures. Once a photosensitivity reaction has occurred, it may be necessary to discontinue the culprit medication and treat the reaction with corticosteroids. For certain medications, long-term surveillance may be indicated because of a higher risk of developing melanoma or squamous cell carcinoma at sites of earlier photosensitivity reactions. A large number of medications have been implicated as causes of photosensitivity, many with convincing clinical and scientific supporting evidence. We review the medical literature regarding the evidence for the culpability of each drug, including the results of phototesting, photopatch testing and rechallenge testing. Amiodarone, chlorpromazine, doxycycline, hydrochlorothiazide, nalidixic acid, naproxen, piroxicam, tetracycline, thioridazine, vemurafenib and voriconazole are among the most consistently implicated and warrant the most precaution by both the physician and patient.
Collapse
Affiliation(s)
- Kim M Blakely
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Aaron M Drucker
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Dermatology, Department of Medicine, Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Cheryl F Rosen
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada. .,Division of Dermatology, Toronto Western Hospital, Toronto, ON, Canada.
| |
Collapse
|
3
|
Abstract
Granuloma formation is usually regarded as a means of defending the host from persistent irritants of either exogenous or endogenous origin. Noninfectious granulomatous disorders of the skin encompass a challenging group of diseases owing to their clinical and histologic overlap. Drug reactions characterized by a granulomatous reaction pattern are rare, and defined by a predominance of histiocytes in the inflammatory infiltrate. This review summarizes current knowledge on the various types of granulomatous drug eruptions, focusing on the 4 major types: interstitial granulomatous drug reaction, drug-induced accelerated rheumatoid nodulosis, drug-induced granuloma annulare, and drug-induced sarcoidosis.
Collapse
Affiliation(s)
- Roni P Dodiuk-Gad
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room M1-737, Toronto, ON M4N 3M5, Canada; Department of Dermatology, Ha'emek Medical Center, Afula 18101, Israel
| | - Neil H Shear
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room M1-737, Toronto, ON M4N 3M5, Canada; Division of Clinical Pharmacology and Toxicology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room M1-737, Toronto, Ontario M4N 3M5, Canada.
| |
Collapse
|
4
|
Yanamandra U, Sahu KK, Malhotra P, Varma S. Photodermatosis secondary to hydroxyurea. BMJ Case Rep 2014; 2014:bcr-2014-205974. [PMID: 25270158 DOI: 10.1136/bcr-2014-205974] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Uday Yanamandra
- Haematology Unit, Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Kamal Kant Sahu
- Haematology Unit, Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Pankaj Malhotra
- Haematology Unit, Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Subhash Varma
- Haematology Unit, Department of Internal Medicine, PGIMER, Chandigarh, India
| |
Collapse
|
5
|
Abstract
Photo-induced drug eruptions are cutaneous adverse events due to exposure to a drug and either ultraviolet or visible radiation. Based on their pathogenesis, they can be classified as phototoxic or photoallergic drug eruptions, although in many cases it is not possible to determine whether a particular eruption is due to a phototoxic or photoallergic mechanism. In this review, the diagnosis, prevention and management of drug-induced photosensitivity are discussed. Diagnosis is based primarily on the history of drug intake and the clinical appearance of the eruption, primarily affecting sun-exposed areas of the skin. Phototesting and photopatch testing can be useful adjuncts in making a diagnosis. The mainstay of management is prevention, including informing patients of the possibility of increased sun sensitivity and the use of sun protective measures. However, once the eruption has occurred, it may be necessary to discontinue the culprit medication and treat the eruption with a potent topical corticosteroid. Drugs that have been implicated in causing photosensitive eruptions are reviewed. Tetracycline, doxycycline, nalidixic acid, voriconazole, amiodarone, hydrochlorothiazide, naproxen, piroxicam, chlorpromazine and thioridazine are among the most commonly implicated medications. We review the medical literature regarding evidence for the culpability of each drug, including the results of phototesting, photopatch testing and rechallenge testing.
Collapse
|
6
|
Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2008. [DOI: 10.1002/pds.1486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|