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Davis AE, Kennelley GE, Amaye-Obu T, Jowdy PF, Ghadersohi S, Nasir-Moin M, Paragh G, Berman HA, Huss WJ. The phenomenon of phototoxicity and long-term risks of commonly prescribed and structurally diverse drugs. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY 2024; 19:100221. [PMID: 38389933 PMCID: PMC10883358 DOI: 10.1016/j.jpap.2023.100221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
Photosensitivity to structurally diverse drugs is a common but under-reported adverse cutaneous reaction and can be classified as phototoxic or photoallergic. Phototoxic reactions occur when the skin is exposed to sunlight after administering topical or systemic medications that exhibit photosensitizing activity. These reactions depend on the dose of medication, degree of exposure to ultraviolet light, type of ultraviolet light, and sufficient skin distribution volume. Accurate prediction of the incidence and phototoxic response severity is challenging due to a paucity of literature, suggesting that phototoxicity may be more frequent than reported. This paper reports an extensive literature review on phototoxic drugs; the review employed pre-determined search criteria that included meta-analyses, systematic reviews, literature reviews, and case reports freely available in full text. Additional reports were identified from reference sections that contributed to the understanding of phototoxicity. The following drugs and/or drug classes are discussed: amiodarone, voriconazole, chlorpromazine, doxycycline, fluoroquinolones, hydrochlorothiazide, nonsteroidal anti-inflammatory drugs, and vemurafenib. In reviewing phototoxic skin reactions, this review highlights drug molecular structures, their reactive pathways, and, as there is a growing association between photosensitizing drugs and the increasing incidence of skin cancer, the consequential long-term implications of photocarcinogenesis.
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Affiliation(s)
- Anna E Davis
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Gabrielle E Kennelley
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- College of Medicine, Central Michigan University, Mt. Pleasant, MI 48858, USA
| | - Tatiana Amaye-Obu
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Peter F Jowdy
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Sarah Ghadersohi
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Mehr Nasir-Moin
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Gyorgy Paragh
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- Department of Cell Stress Biology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Harvey A Berman
- Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Romanell Center for the Philosophy of Medicine and Bioethics, Park Hall University at Buffalo, Buffalo, NY 14260, USA
| | - Wendy J Huss
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- Department of Cell Stress Biology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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Propylene Glycol Improves Stability of the Anti-Inflammatory Compounds in Scutellaria baicalensis Extract. Processes (Basel) 2021. [DOI: 10.3390/pr9050894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Scutellaria baicalensis root extracts have been useful for external skin care and have been commercialized for years. Here, a comprehensive study was conducted to investigate the difference between 20% propylene glycol (PG) and water used as the storage solvent for a time course analysis of their remaining biological activities and ingredient compositions versus their freshly prepared conditions. Of the four major components in the 20% PG solvent, more than 80% of the components were retained after storage for two months, but in water only baicalin and wogonin were retained. The relative antibacterial activities, antioxidant properties and anti-inflammatory activities of the 20% PG solvent group were better than those of the water solvent group. Taken together, we demonstrated that these activities improved when PG, a common solvent used in many product formulas, was used as the storage solvent for the S. baicalensis extract.
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Morris S, Shaw A. Is it safe to use visible blue light-emitting diode phototherapy for neonatal jaundice in infants who are also treated with amiodarone? Eur J Hosp Pharm 2020; 29:237-238. [PMID: 33051195 DOI: 10.1136/ejhpharm-2020-002352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/02/2020] [Accepted: 09/15/2020] [Indexed: 11/04/2022] Open
Abstract
Amiodarone is a useful treatment for neonatal cardiac arrhythmias. A minority of neonates with arrhythmias treated with amiodarone may also develop neonatal jaundice. Phototherapy is recommended to treat neonatal jaundice. However, amiodarone is known to cause skin reactions when patients are exposed to light. Therefore phototherapy may not be administered due to concerns about this interaction. Exchange transfusions are used as an alternative to phototherapy to avoid the interaction. However, exchange transfusions are associated with serious complications such as the transmission of bloodborne disease, seizures and haemodynamic instability. We report a literature review and outcome of a premature infant treated with amiodarone and visible blue light-emitting diode (LED) phototherapy. Phototherapy was used for 54 hours and no skin reactions were observed. This is because visible blue LED phototherapy lamps emit predominantly visible light. Therefore exposure to ultraviolet light that is known to cause amiodarone phototoxicity is minimised.
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Affiliation(s)
- Stephen Morris
- Medicines Management and Pharmacy Services, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Amelia Shaw
- Leeds Centre for Newborn Care, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Joshi KM, Gill MK. Amiodarone: A potential risk factor for retinal phototoxicity. Am J Ophthalmol Case Rep 2016; 5:119-123. [PMID: 29503963 PMCID: PMC5758025 DOI: 10.1016/j.ajoc.2016.12.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 12/15/2016] [Accepted: 12/28/2016] [Indexed: 11/25/2022] Open
Abstract
Purpose To report the only known case, to our knowledge, of amiodarone induced retinal phototoxicity following vitrectomy surgery. Observations A 66-year-old male presented with visual acuity of 20/150 OS secondary to an epiretinal membrane (ERM). Patient was on oral amiodarone for atrial fibrillation. Baseline spectral domain optical coherence tomography (SD-OCT) revealed an ERM with retinal thickening and schisis. The patient underwent an uncomplicated pars plana vitrectomy and membrane peel using standard vitrectomy settings and illumination. Triamcinolone was used to stain the ERM intraoperatively. ICG was not used. On post-operative day one, vision was count finger (CF) at 1′. At post-operative week one, vision was unchanged and SD-OCT showed macular edema. At post-operative month one, vision remained CF at 1′ and macular edema resolved with residual pigmentary changes and subretinal fibrosis resembling phototoxic damage. SD-OCT at one month showed resolution of macular edema, retinal pigment epithelium hyperplasia and an indistinct ellipsoid layer. Fluorescein angiography did not show any neovascularization. At three month follow-up, patient's vision, exam and OCT findings remained unchanged. Conclusions and importance Many pharmacologic agents have the ability to alter a patient's sensitivity to solar or artificial radiation. Drugs act as photosensitizers that lead to photochemical damage. Amiodarone has been reported to have such photosensitizing properties in humans. This report describes a case of retinal phototoxicity from intraoperative light exposure photosensitized by systemic amiodarone use.
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Affiliation(s)
- Komal M Joshi
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, 645 N. Michigan Avenue, Suite 440, Chicago, IL, USA
| | - Manjot K Gill
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, 645 N. Michigan Avenue, Suite 440, Chicago, IL, USA
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Jaworski K, Walecka I, Rudnicka L, Gnatowski M, Kosior DA. Cutaneous adverse reactions of amiodarone. Med Sci Monit 2014; 20:2369-72. [PMID: 25413691 PMCID: PMC4250032 DOI: 10.12659/msm.890881] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Dermatological complications of amiodarone are commonly encountered problems in therapy. The incidence in the population of patients with prolonged use of amiodarone reaches nearly 75% according to various sources. Nevertheless, they are often misdiagnosed or overlooked. The aim of this review is to present the current state of knowledge about skin changes induced by amiodarone, including phototoxic and photoallergic reactions, as well as hyperpigmentation. In most cases, the adverse effects are reversible and disappear after discontinuation of the drug. Although the dermatological complications usually do not influence the outcome of the therapy and rarely cause discontinuation of treatment, they have a great impact on patient quality of life.
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Affiliation(s)
- Krzysztof Jaworski
- Department of Cardiology and Hypertension, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland
| | - Irena Walecka
- Department of Dermatology, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Maciej Gnatowski
- Department of Traumaorthopedic Surgery, District Hospital, Wołomin, Poland
| | - Dariusz A Kosior
- Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
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