Medical Care

The mainstays of treatment of drug-induced photosensitivity include identification and avoidance of the causative agent, the use of sun protection, and the institution of measures for symptomatic relief.

Topical corticosteroids and cool compresses may alleviate drug-induced photosensitivity. The use of systemic corticosteroids should be reserved for the most severe cases.

If sunscreens are not the cause of the photosensitivity, they should be used liberally. The sun protection factor (SPF) may not be a reliable indicator of protection against drug-induced photosensitivity. The SPF refers to the degree of protection against sunlight-induced sunburn, primarily that caused by UV-B. Most drug-induced photosensitivity reactions are caused by wavelengths within the UV-A range. Therefore, sunscreens that absorb UV-A should be prescribed. Sunscreens that contain avobenzone (Parsol 1789), titanium dioxide, and zinc oxide are more effective in blocking out UV-A radiation than sunscreens that contain other ingredients. Polypodium leucotomos shows promise.^[37]

Prevention

Patients who experience drug-induced photosensitivity should identify and avoid the causative agent. Patients should use a sunscreen if it is not the offending agent. Sun protection often prevents photosensitivity reactions.

Medication

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Media Gallery

Phototoxic reaction.
Photoallergic reaction.
Pseudoporphyria.
Subacute cutaneous lupus erythematosus exacerbated by terbinafine. Courtesy of Jeffrey P. Callen.

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Table 1. Common Photosensitizing Medications

Class	Medication	Photo-toxic Reaction	Photo-allergic Reaction	Lichenoid Reaction	Pseudo-porphyria	Subacute Cutaneous Lupus Erythematosus
Antibiotics	Tetracyclines (doxycycline, tetracycline)	Yes	No	Yes	Yes	No
	Fluoroquinolones (ciprofloxacin, ofloxacin, levofloxacin)^[10]	Yes	No	No	No	No
	Sulfonamides	Yes	No	No	No	No
Nonsteroidal anti-inflammatory drugs^[11]	Ibuprofen	Yes	No	Yes	No	No
	Ketoprofen^[12]	Yes	Yes	No	No	No
	Naproxen^[13]	Yes	No	Yes	Yes	No
	Celecoxib^[14]	No	Yes	No	Yes	No
Diuretics	Furosemide	Yes	No	No	Yes	No
	Bumetanide	No	No	No	Yes	No
	Hydro-chlorothiazide	Yes	No	No	No	Yes
Retinoid	Isotretinoin	Yes	No	No	No	No
Retinoid	Acitretin	Yes	No	No	No	No
Hypoglycemics	Sulfonylureas (glipizide, glyburide)^[10]	No	Yes	Yes	Yes	No
HMG-CoA* reductase inhibitors	Statins (atorvastatin, fluvastatin, lovastatin, pravastatin, simvastatin)^[15]	Yes	Yes	Yes	Yes	No
Epidermal growth factor receptor inhibitors	Cetuximab, panitumumab, erlotinib, gefitinib, lapatinib, vandetanib^[16]	Yes	Yes	Yes	Yes	No
BRAF inhibitors	Vemurafenib,^{[6, 7, 8, 17]}sorafenib	Yes	No	No	No	Yes
Photodynamic therapy prophoto-sensitizers	5-Aminolevulinic acid^[18]	Yes	No	No	No	No
	Methyl-5-aminolevulinic acid	Yes	No	No	No	No
	Verteporfin^[19]	Yes	No	No	No	No
	Photofrin^[20]	Yes	No	No	No	No
Neuroleptic drugs^[21]	Phenothiazines (chlorpromazine, fluphenazine, perazine, perphenazine, thioridazine)^[22]	Yes	Yes	Yes	No	No
Neuroleptic drugs^[21]	Thioxanthenes (chlorprothixene, thiothixene)	Yes	No	No	No	No
Antifungals	Terbinafine	No	No	No	No	Yes
	Itraconazole	Yes	Yes	No	No	No
	Voriconazole^{[23, 24, 25, 26]}	Yes	No	No	Yes	No
	Griseofulvin	Yes	Yes	No	No	Yes
Other drugs	Para-aminobenzoic acid	Yes	Yes	No	No	No
	5-Fluorouracil	Yes	Yes	Yes	Yes	No
	Paclitaxel^{[11, 27]}	Yes	No	No	No	Yes
	Amiodarone	Yes	No	No	Yes	No
	Diltiazem	Yes	No	No	No	Yes
	Quinidine	Yes	Yes	Yes	No	No
	Hydroxychloroquine	No	No	Yes	No	No
	Coal tar	Yes	No	No	No	No
	Enalapril	No	No	No	No	Yes
	Dapsone	No	Yes	Yes	Yes	No
	Oral contraceptives^{[28, 29]}	No	Yes	No	Yes	No
Sunscreens^[30]	Para-aminobenzoic acid	No	Yes	No	No	No
	Cinnamates	No	Yes	No	No	No
	Benzophenones	No	Yes	No	No	No
	Salicylates	No	Yes	No	No	No
Fragrances	Musk ambrette	No	Yes	No	No	No
Fragrances	6-Methylcoumarin	No	Yes	No	No	No
*3-Hydroxy-3-methylglutaryl coenzyme A.

Table 2. Distinguishing Characteristics of Phototoxic and Photoallergic Reactions

Feature	Phototoxic Reaction	Photoallergic Reaction
Incidence	High	Low
Amount of agent required for photosensitivity	Large	Small
Onset of reaction after exposure to agent and light	Minutes to hours	24-72 hours
More than one exposure to agent required	No	Yes
Distribution	Sun-exposed skin only	Sun-exposed skin, may spread to unexposed areas
Clinical characteristics	Exaggerated sunburn	Dermatitis
Immunologically mediated	No	Yes; Type IV

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Author

Alexandra Y Zhang, MD Staff Physician, Dermatology and Plastic Institute, Cleveland Clinic Foundation

Alexandra Y Zhang, MD is a member of the following medical societies: American Academy of Dermatology, Women's Dermatologic Society, Dermatology Foundation

Disclosure: Nothing to disclose.

Coauthor(s)

Craig A Elmets, MD Professor and Chair, Department of Dermatology, Director, Chemoprevention Program Director, Comprehensive Cancer Center, UAB Skin Diseases Research Center, University of Alabama at Birmingham School of Medicine

Craig A Elmets, MD is a member of the following medical societies: American Academy of Dermatology, American Association of Immunologists, American College of Physicians, American Federation for Medical Research, Society for Investigative Dermatology

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: University of Alabama at Birmingham; University of Alabama Health Services Foundation<br/>Serve(d) as a speaker or a member of a speakers bureau for: Ferndale Laboratories<br/>Received research grant from: NIH, Veterans Administration, California Grape Assn<br/>Received consulting fee from Astellas for review panel membership; Received salary from Massachusetts Medical Society for employment; Received salary from UpToDate for employment. for: Astellas.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

Disclosure: Nothing to disclose.

Jeffrey P Callen, MD Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School of Medicine

Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, American College of Rheumatology

Disclosure: Received income in an amount equal to or greater than $250 from: Biogen US (Adjudicator for study entry cutaneous lupus erythematosus); Priovant (Adjudicator for entry into a dermatomyositis study); IQVIA (Serono - adjudicator for a study of cutaneous LE) <br/>Received honoraria from UpToDate for author/editor; Received royalty from Elsevier for book author/editor; Received dividends from trust accounts, but I do not control these accounts, and have directed our managers to divest pharmaceutical stocks as is fiscally prudent from Stock holdings in various trust accounts include some pharmaceutical companies and device makers for these trust accounts for: Stocks held in various trust accounts: Allergen; Amgen; Pfizer; 3M; Johnson and Johnson; Merck; Abbott Laboratories; AbbVie; Procter and Gamble;; Celgene; Gilead; CVS; Walgreens; Bristol-Myers Squibb.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Abdul-Ghani Kibbi, MD, FACP Professor and Chair, Department of Dermatology, American University of Beirut Medical Center, Lebanon

Disclosure: Nothing to disclose.

Drug-Induced Photosensitivity Treatment & Management

Medical Care

Prevention

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