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Wirth P, Cartee TV, Lam C. Numerous Ulcerated Plaques of the Trunk and Extremities in a Patient Receiving Long-term Hydroxyurea Therapy. JAMA Dermatol 2023; 159:450-451. [PMID: 36811868 DOI: 10.1001/jamadermatol.2022.6602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
A woman in her 80s initially presented with numerous, primarily photodistributed, crusted, and ulcerated plaques of the trunk and extremities and a medical history of essential thrombocytosis treated with hydroxyurea for 14 years. What is your diagnosis?
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Affiliation(s)
- Paul Wirth
- Buffalo Medical Group, Buffalo, New York
| | - Todd V Cartee
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Charlene Lam
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
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2
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Kowalska J, Rok J, Rzepka Z, Wrześniok D. Drug-Induced Photosensitivity-From Light and Chemistry to Biological Reactions and Clinical Symptoms. Pharmaceuticals (Basel) 2021; 14:723. [PMID: 34451820 PMCID: PMC8401619 DOI: 10.3390/ph14080723] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/23/2021] [Accepted: 07/24/2021] [Indexed: 02/07/2023] Open
Abstract
Photosensitivity is one of the most common cutaneous adverse drug reactions. There are two types of drug-induced photosensitivity: photoallergy and phototoxicity. Currently, the number of photosensitization cases is constantly increasing due to excessive exposure to sunlight, the aesthetic value of a tan, and the increasing number of photosensitizing substances in food, dietary supplements, and pharmaceutical and cosmetic products. The risk of photosensitivity reactions relates to several hundred externally and systemically administered drugs, including nonsteroidal anti-inflammatory, cardiovascular, psychotropic, antimicrobial, antihyperlipidemic, and antineoplastic drugs. Photosensitivity reactions often lead to hospitalization, additional treatment, medical management, decrease in patient's comfort, and the limitations of drug usage. Mechanisms of drug-induced photosensitivity are complex and are observed at a cellular, molecular, and biochemical level. Photoexcitation and photoconversion of drugs trigger multidirectional biological reactions, including oxidative stress, inflammation, and changes in melanin synthesis. These effects contribute to the appearance of the following symptoms: erythema, swelling, blisters, exudation, peeling, burning, itching, and hyperpigmentation of the skin. This article reviews in detail the chemical and biological basis of drug-induced photosensitivity. The following factors are considered: the chemical properties, the influence of individual ranges of sunlight, the presence of melanin biopolymers, and the defense mechanisms of particular types of tested cells.
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Affiliation(s)
| | | | | | - Dorota Wrześniok
- Department of Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia in Katowice, Jagiellońska 4, 41-200 Sosnowiec, Poland; (J.K.); (J.R.); (Z.R.)
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3
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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.
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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.)
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4
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Sahu KK, Mishra AK, Lal A, George SV, Siddiqui AD. Clinical spectrum, risk factors, management and outcome of patients with retroperitoneal hematoma: a retrospective analysis of 3-year experience. Expert Rev Hematol 2020; 13:545-555. [PMID: 32089021 DOI: 10.1080/17474086.2020.1733963] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Kamal Kant Sahu
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA
| | - Ajay Kumar Mishra
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA
| | - Amos Lal
- Department of Medicine Performance Improvement Committee, Saint Vincent Hospital, Worcester, MA, USA
| | - Susan V. George
- Department of Medicine Performance Improvement Committee, Saint Vincent Hospital, Worcester, MA, USA
- Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Ahmad Daniyal Siddiqui
- Hemato-Oncology, Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA
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5
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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.
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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.
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Sahu KK, Mishra AK, Lal A, Gandhi R. Acute generalised skin rash secondary to the Nystatin Oral Suspension. BMJ Case Rep 2019; 12:12/5/e230600. [PMID: 31138598 DOI: 10.1136/bcr-2019-230600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Kamal Kant Sahu
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA
| | - Ajay Kumar Mishra
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA
| | - Amos Lal
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA
| | - Rahul Gandhi
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA
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7
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Monteiro AF, Rato M, Martins C. Drug-induced photosensitivity: Photoallergic and phototoxic reactions. Clin Dermatol 2016; 34:571-81. [PMID: 27638435 DOI: 10.1016/j.clindermatol.2016.05.006] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Drug-induced photosensitivity refers to the development of cutaneous disease due to the interaction between a given chemical agent and sunlight. Photosensitivity reactions can be classified as phototoxic or photoallergic. Sometimes, there is an overlap between these two patterns, making their distinction particularly difficult for the clinician. We review the drugs that have been implicated as photosensitizers, the involved mechanism, and their clinical presentations. The main topical agents that cause contact photosensitivity are the nonsteroidal antiinflammatory drugs, whereas the main systemic drugs inducing photosensitivity are antimicrobials, nonsteroidal antiinflammatory agents, and cardiovascular drugs. Drug-induced photosensitivity remains a common clinical problem and is often underdiagnosed.
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Affiliation(s)
- Ana Filipe Monteiro
- Department of Dermatovenereology, Hospital Distrital de Santarém EPE, Santarém, Portugal.
| | - Margarida Rato
- Department of Dermatovenereology, Hospital Distrital de Santarém EPE, Santarém, Portugal
| | - César Martins
- Department of Dermatovenereology, Hospital Distrital de Santarém EPE, Santarém, Portugal
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