Systemic drug photosensitivity—Culprits, impact and investigation in 122 patients

Research output: Contribution to journalArticlepeer-review

  • External authors:
  • Amirah Alrashidi
  • Jennifer C. H. Sharif
  • Firas C. Kreeshan
  • Tashmeeta Ahad

Abstract

Background
Systemic drugs are a potentially reversible cause of photosensitivity. We explore prevalence, impact, phototest findings and culprit drugs.

Methods
Retrospective review of patients was diagnosed with drug‐induced photosensitivity in a specialist photoinvestigation centre (2000‐2016), using data recorded in standardized pro forma. Patients underwent detailed clinical evaluation. Monochromator phototesting was performed to 300 ± 5 nm, 320 ± 10 nm, 330 ± 10 nm, 350 ± 20 nm, 370 ± 20 nm, 400 ± 20 nm, 500 ± 20nm and 600 ± 20 nm. Broadband UVA and solar‐simulated radiation (SSR) testing were performed, and photopatch testing and laboratory tests examined for other causes of photosensitivity. DLQI was evaluated.

Results
Prevalence of drug‐induced photosensitivity was 5.4% (122/2243) patients presenting with photosensitivity. Patients with drug‐induced photosensitivity were 52.5% female; median 62 years (range 11‐86); phototype I (17.2%), II (39.3%), III (26.2%), IV (6.5%), V (4.1%). Fifty‐five (45.1%) patients had reduced erythemal thresholds on monochromator phototesting: 83.6%% to UVA alone, 14.5% to both UVA and UVB, 1.8% to UVA and visible light; 61.4% (n = 75) showed abnormal response to broadband UVR. Drugs implicated: quinine (11.5%), diuretics (10.7%; thiazide 9.8%), antifungals (9.8%), proton‐pump‐inhibitors (9.8%), angiotensin‐converting enzyme inhibitors (7.4%), anti‐inflammatory drugs (6.6%), statins (5.7%), selective serotonin reuptake inhibitors (4.9%), calcium channel antagonists (3.3%), anti‐epileptics (3.3%), tricyclic antidepressants (3.3%), beta‐blockers (2.5%), antibiotics (2.5%), others (≤1.6% cases each). Emerging culprits included azathioprine (2.5%) and biologics (TNF‐α inhibitors, denosumab; 2.5%). Median DLQI was 11 (range 2‐27) for the past year.

Conclusion
Classically described photosensitizing drugs such as thiazides and quinine remain common offenders, while emerging culprits include biologics such as TNF‐a inhibitors and proton‐pump‐inhibitors. There is very large impact on life quality; identification facilitates measures including drug cessation and implementation of appropriate photoprotection.

Bibliographical metadata

Original languageEnglish
JournalPhotodermatology Photoimmunology and Photomedicine
Early online date21 Jun 2020
DOIs
Publication statusE-pub ahead of print - 21 Jun 2020