1Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy, 2Department of Clinical and Experimental Medicine, Pharmacology, University of Messina, Messina, Italy, 3Laboratory of Clinical Biochemistry, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy, 4Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy, 5S.C. Azathioprine treatment photosensitizes human skin to ultraviolet A radiation, Incidence and risk factors for nonmelanoma skin cancer after heart transplantation. The drugs leading to pellagrous dermatitis can interfere with niacin/NAD metabolism by inhibiting niacin production from dietary tryptophan and by acting as NAD analogs due to their structural similarity (48). Globally the incidence is likely lower, even in the light of a higher dark figure. The exact number of drugs reported differs substantially between these reviews, but drugs of the following drug classes are present in all published lists of photosensitive drugs: nonsteroidal antiinflammatory drugs (NSAIDs), antimicrobials, antihypertensives and antineoplastic drugs [3, 9]40]. These include: Polymorphic light eruption Juvenile spring eruption Actinic folliculitis Actinic prurigo Solar urticaria Chronic actinic/photosensitivity dermatitis Hydroa vacciniforme (associated with Epstein-Barr virus ). FB and GC verified the accuracy of all pharmacological and molecular information given in the review. In addition to these classical types, DI-PTRs and DI-PARs may presented several subtypes. sharing sensitive information, make sure youre on a federal Clinically, photosensitive reactions involve sun-exposed areas, namely the face, V of the neck and extensor, forearms and hands (6). The .gov means its official. In the first case, the drugs could act by amplifying the energy of UV rays and releasing it in well-defined areas of the skin, causing alteration in the production of melanin. A combined effect of different wavelengths has also been described [ 4 ]. However, these numbers only represent the portion of photosensitive reactions among (clinically apparent) photodermatoses; the incidence of druginduced photosensitivity itself is not known. Erectile dysfunction (ED) is often a symptom . Risk of cutaneous carcinoma in patients treated with oral methoxsalen photochemotherapy for psoriasis, Nonmelanoma skin cancer occurring in patients treated with PUVA five to ten years after first treatment. Rodrguez-Pazos L, Gmez-Bernal S, Rodrguez-Granados MT, Toribio J. Drug-induced lupus: an update on its dermatologic aspects. Comparison of photodermatoses in AfricanAmericans and Caucasians: a followup study, Skintone discrimination by Whites and Africans is associated with the acculturation of African immigrants in Norway, Evaluation of druginduced photosensitivity using the Japanese adverse drug event report (JADER) database, Use of antihypertensive drugs and risk of skin cancer, The frequency of photosensitizing drug dispensings in Austria and Germany: a correlation with their photosensitizing potential based on published literature, Druginduced phototoxicity: A systematic review, Druginduced photosensitivityan update: culprit drugs, prevention and management, ATC/DDD Index 2020. Cutaneous adverse drug reactions have been observed in 2%-3% of hospitalized patients. Such factors include susceptibility to solar radiation, patient age, cumulative dose and/or duration of treatment as well as other factors as yet unknown [42]. Drug-induced photopigmentation should be distinguished from some forms of drug-induced hyperpigmentation that are not only related to solar exposure, such as tetracycline-induced hyperpigmentation. Hyperpigmentation of the skin is a common side effect of many drugs (85). Drug-induced lupus erythematosus (DILE) is defined as an entity characterized by clinical manifestations and immune-pathological serum findings similar to those of idiopathic lupus but which is related to continuous drug exposure and resolves after discontinuation of the offending drug (99). Introduction The D.C. Telehealth Reimbursement Act of 2013 directs Medicaid to "cover and The skin reactions vary depending on the responsible photosensitizer and its respective intracellular target, with some sensitizers even affecting multiple sites [9]. Other drugs for which an increased risk of skin cancer has been reported include: NSAIDs and fluoroquinolones [45], thiazide diuretics [43, 44]49, 50], tetracyclines [44], amiloride [43], amiodarone [51, 52], azathioprine [53, 54], vemurafenib [55, 56] and voriconazole [57, 58]. DI-SCLE has been described with drugs listed in Table 1 (78, 79). Drug-induced PEM has been described with many drugs listed in Table 1 (7076). Recently discovered photosensitizers (2005 and later) are labeled with an asterisk. This implies that in photoallergic reactions the cutaneous changes increase during the course of the disease, with a peak at about 4872hours after the onset of symptoms (crescendo pattern). Accessibility Phototoxic tissue damage is characterized histologically by dermal edema, dyskeratosis and necrosis of keratinocytes, in severe cases even panepidermal [1, 12]. Certain medicines or chemicals can make your skin sensitive to the sun. The diagnosis is usually based on a doctor's evaluation. photosensitivity, phototoxicity, photoallergy, drug reaction, pathogenetic mechanisms, patient education, Drug-induced cutaneous photosensitivity: incidence, mechanism, prevention and management, Clinical drug photosensitivity. Drug-induced photosensitivity reactions refer to the development of cutaneous disease as a result of the combined effects of a drug and light (mostly spectrum within the UVA and visible light range or UVB range). To date, the control of DIP is based on prompt recognition of its clinical subtypes by dermatologists and sun-exposure education of patients using drugs with potential photosensitivity. Breier F, Feldmann R, Pelzl M, Gschnait F. Pseudoporphyria cutanea tarda induced by furosemide in a patient undergoing peritoneal dialysis, Pseudoporphyria due to dyazide in a patient with vitiligo, Pseudoporphyria complicating etretinate therapy. Photosensitive drug-induced lichenoid reactions have been described with drugs listed in Table 1 (5465, 6769, 72). Patri A, Fabbrocini G, Megna M, Lauro W, D'Onofrio P, Gallo L. Itraconazole-induced photodistributed erythema multiforme. Medical University of Vienna, 1. Vaccaro M, Borgia F, Barbuzza O, Guarneri B. Photodistributed eruptive telangiectasia: an uncommon adverse drug reaction to venlafaxine. ROS and the DNA damage response in cancer. found that the majority of reports focusing on this issue stem mainly from case reports and case series [40]. Tetracyclines and photosensitive skin reactions: A narrative review, Studies of laminin and type IV collagen in blisters of porphyria cutanea tarda and drug-induced pseudoporphyria. DIP includes phototoxicity and photoallergy. Agents and compounds are not equally distributed among the different drug classes. People develop itchy eruptions or areas of redness and inflammation on patches of sun-exposed skin. The ultraviolet protection factor (UPF) is a measure of ultraviolet radiation penetration through the fabric (103). sore throat. Symptoms similar to severe sunburn. Kim etal. 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 Hyperpigmentation and telangiectasia are additional longterm features. ED is often a symptom of another health problem or health-related factor. Delayedonset erythema is often referred to as with exaggerated sunburn. Itchy blisters. government site. There are many causes of photosensitivity, such as reactions to certain medications and underlying health conditions. Exposure to UVB and inflammatory response may increase melanin production, by regulating cutaneous levels of pro-opiomelanocortin (POMC) mRNA, POMC peptides, and melanocyte stimulating hormone (MSH) receptors (87). This may also help relieve itching. Furthermore, the absorption spectrum of the administered drug has been related to the histologic type of skin cancer. being unable to get an erection at any time. Patients exposed to high levels of solar radiation, for occupational or environmental reasons, should be especially careful while taking photosensitizing drugs: that's the case of travelers taking doxycycline for prophylaxis of malaria, which is endemic in tropical countries close to equator (105). 2019[Online] 2019 [cited 2020], Photosensitizing agents and the risk of nonmelanoma skin cancer: a populationbased casecontrol study. On the other hand, chronic accumulation of photosensitive drugs or their metabolites in dermis may determine hyperpigmentation or dyschromia, as in case of amiodarone-induced photosensitivity (18). A retrospective analysis of reports to the Norwegian Adverse Drug Reactions Committee from the years 19701994. Oxidation of cellular lipids damages cellular components, which results in the clinically apparent skin reaction. The group Antiinflammatory contains the lowest number of agents (n = 38). In addition, a systematic comparative analysis of the photosensitive potential of different photosensitizers would be desirable but is lacking so far. Photosensitive reactions occur mainly in the UVA range (wavelength 315400 nm), although some drugs produce photosensitivity upon exposure to UVB radiations (280315 nm) or even visible light (400740 nm) (3). swelling of the feet or lower legs. The https:// ensures that you are connecting to the Careers, Unable to load your collection due to an error. FOIA DI-DLE has been described with drugs listed in Table 1 (8184). Sun safety programs for DIP patients appear essential, considering that currently an appropriate sun protection education is the only way to prevent DIP and the only alternative therapy to drug withdrawal. Bethesda, MD 20894, Web Policies Photodistributed telangiectasia induced by calcium channel blockers: case report and review of the literature, Pellagra a review exploring causes and mechanisms, including isoniazid-induced pellagra. The predominant pathogenesis is topically induced photoallergic contact dermatitis, while photoallergy induced by systemic agents is rather rare [29, 30]. Pellagra like reactions have been described with drugs listed in Table 1 (4853). This reaction may clinically manifest as greater propensity toward sunburn or development of a rash upon exposure to solar radiation. Treatment is based on the withdrawal of the offending drug and sun protection, especially against UVA wavelengths. Drug photosensitivity, idiopathic photodermatoses, and sunscreens, Drug and chemical induced photosensitivity from a clinical perspective, Clinical drug photosensitivity. Druginduced 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. 8600 Rockville Pike Photosensitivity is an immune reaction to ultraviolet (UV) rays from sunlight or other lights. However, the majority of phototoxic reactions result from UVA exposure [7, 20]22]. The dorsal hands are most commonly affected, but fingers, extensor legs, upper chest and face may also be involved (90). Diagnosis of photosensitive drug eruptions relies on obtaining a detailed medical history, in particular the chronology of medication with respect to the onset of the event [40]. They can develop a few minutes or hours after taking the drug and the main symptoms are as follows: Erythema and edema. Drug-induced subacute cutaneous lupus erythematous (DI-SCLE) is characterized by annular polycyclic and/or papulosquamous lesions and frequent presence of anti-Ro/SSA antibodies, but the incidence of anti-Ro/SSA antibodies appears to be lower than in idiopathic SCLE. Photosensitivity causes red, itchy patches on your skin, usually skin that has been in sunlight. However, out of 245 cases of druginduced photosensitivity diagnosed at the Dundee Photobiology Unit between 1970 and 2000, just a single case (0.04%) was confirmed as a photoallergy [9]. Pathogenetic initial stages of DI-PRTs and DI-PARs are similar. Accessibility Clinically, it is characterized by the presence of diarrhea, dementia, and dermatitis (48). The reaction is dose-independent. Photosensitivity reactions are induced by a delimited range of the electromagnetic spectrum that includes visible light and UV radiation. Therefore, sunscreens that absorb UV-A should be prescribed. The World Health Organization defines an adverse drug reaction (ADR) as "a response to a drug which is noxious and unintended, and which occurs at doses normally used in man for the prophylaxis, diagnosis, or therapy of disease, or the modifications of physiological function". Asterisks identify agents of which the first report concerning their photosensitizing effects havebeen published recently (2005 and later). The process is termed photosensitization and the initiator is the photosensitizer (1). The complete depiction of a complex matter such as druginduced photosensitivity in a single publication seems almost impossible, given the numerous reports on this topic. Drug-induced photosensitivity (DIP) is a common cutaneous adverse drug reaction, resulting from the interaction of ultraviolet radiations (UVR) with drugs ().DIP may account for up to 8% of all cutaneous adverse drug reactions ().Photosensitive reactions occur mainly in the UVA range (wavelength 315-400 nm), although some drugs produce photosensitivity upon exposure to UVB . Appropriate topical steroids are an option for acute phototoxic cases. No use, distribution or reproduction is permitted which does not comply with these terms. Bethesda, MD 20894, Web Policies It may occur after acute phototoxic reaction or be the sole feature (86). per dose 20 mg), to be taken approximately 25-60 minutes before sexual activity, subsequent doses adjusted according to response, onset of effect may be delayed if taken with high-fat meal; maximum 1 dose per day. 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