Chemical- and Drug-Induced Photosensitivity

Chemical- and Drug-Induced Photosensitivity

Chemical- and Drug-Induced Photosensitivity
Photosensitivity induced by exogenous agents
Introduction

Photosensitivity1



 Exogenous agents induce photodermatitis by two mechanisms:


 Phototoxicity

 Direct tissue damage caused by phototoxic agent and light
 In all individuals ( adequate doses of agent and light)

 Photoallergy

 Type 4 hypersensitivity
 In sensitized individuals with minimal concentration of photoallergen


 In photodermatology referral centers

 5 to 15% phototoxicity
 4% to 8% photoallergy

Pathogenesis

 Phototoxicity

 Generation of oxygen free radicals, superoxide anions, hydroxyl radicals and singlet oxygen, leads to a cytotoxic tissue effects


 Other mechanisms include:

 Formation of photoadducts reported with psoralens
 Generation of inflammatory mediators reported with porphyrins and demeclocyclines
 Apoptosis, PDT is a potent iducer of apoptosis in adition to generating reactive oxygen products

 Photoallergy

 UV energy convert a photoallergen to an excited state molecule or a stable photoproduct which could conjugate with a carrier protein to form a complete Ag .
 Once the NeoAg is formed the mechanism of photoallergy is identical to that of allergic contact dermatitis:
 APC T cells Type 4 hypersensitivity

Photosensitivity2

Clinical features

 Phototoxicity

 Sun burn reaction is the prototype
 Develops within hours; for the vast majority of agents
 Erythema and edema as well as burning and stinging sensations
 vesicles and bullae seen in severely affected patients
 These reactions then resolve spontaneously with desquamation and hyperpigmentation once the photosensitizer or UVR is avoided.

Photosensitivity3 Photosensitivity4

Photosensitivity5 Photosensitivity6

Photosensitivity7 Photosensitivity8

Photosensitivity9 Photosensitivity10

Photosensitivity11


Other less common manifestations of phototoxicity
 Pseudoporphyria
 NSAIDs, especially naproxen
 photo-onycholysis
 Tetracyclines and psoralens, fluoroquinolones
 slate-gray hyperpigmentation
 amiodarone, chlorpromazine, tricyclic antidepressants and diltiazem
 lichenoid eruptions
 quinine and quinidine
 Burning or painful sensation
 Amiodarone
 Evolution to CAD
 thiazides, quinidine, quinine or simvastatin


A woman taking naproxen while using tanning booths

Photosensitivity12


Pseudoporphyria in a haemodialysis patient

Photosensitivity13


Other less common manifestations of phototoxicity
 Pseudoporphyria

 NSAIDs, especially naproxen
 photo-onycholysis
 Tetracyclines and psoralens, fluoroquinolones
 slate-gray hyperpigmentation
 amiodarone, chlorpromazine, tricyclic antidepressants and diltiazem
 lichenoid eruptions
 quinine and quinidine
 Burning or painful sensation
 Amiodarone
 Evolution to CAD
 thiazides, quinidine, quinine or simvastatin


Photo-onycholysis induced by doxycycline

Photosensitivity14


Other less common manifestations of phototoxicity
 Pseudoporphyria
 NSAIDs, especially naproxen
 photo-onycholysis
 Tetracyclines and psoralens, fluoroquinolones
 slate-gray hyperpigmentation
 amiodarone, chlorpromazine, tricyclic antidepressants and diltiazem

Photosensitivity15


Other phototoxicity related features Photosensitivity16
 Exacerbation of 5-FU-induced inflammation in sites with actinic keratoses

 Methotrexate occasionally causes a recurrence ('recall') of previous UVR-induced erythema
 UVR-induced erythema is most likely due to retinoid-induced thinning of the stratum corneum
 Phytophotodermatitis
 Linear streaks of erythema occurring a day or so after skin contact with plants containing furocoumarins + exposure to sunlight
 Yarrowبومادران , parsley (جعفری), celery (کرفس), lime and fig (انجیر), parsnip (هویج وحشی), carrots, fennel (رازیانه), dill(شوید), hogweed (نوعی هویچ وحشی)
 In Roofers and road workers tar and concomitant UVA induce phototoxicity


Phytophotocontact dermatitis

Photosensitivity17


Cow parsnip rash

Photosensitivity18 Photosensitivity19

Photosensitivity20 Photosensitivity21


Common phototoxic agents
 Antiarrhythmics
 Amiodarone, Quinidine
 Triazole antifungals
 - Voriconazole
 Diuretics
 Furosemide, Thiazides Photosensitivity22
 Nonsteroidal anti-inflammatory Drugs
 Nabumetone, Naproxen, Piroxicam
 Phenothiazines
 Chlorpromazine,Prochlorperazine
 Psoralens
 Methoxypsoralen,8-Methoxypsoralen, 4,5',8-Trimethylpsoralen
 Quinolones
 Ciprofloxacin
 Lomefloxacin
 Nalidixic acid
 Sparfloxacin
 St. John's wort
 Hypericin
 Sulfonamides
 Sulfonylureas
 Tar (topical)
 Tetracyclines
 Doxycycline, Demeclocycline

Hypericin is one of the active compounds that were identified in the plant called St. John’s Wort that is nowadays used on a large scale in treating depression

Clinical features


 Photoallergy
 A pruritic eczematous eruption in sun exposed area very similar to allergic CD
 Vesicles and bullae in more severely affected patients and less commonly than in phototoxic reactions
 PIH is rare ( unlike phototoxic reactions )
 lichenoid eruptions
 HCTZ, quinine and quinidine
 Evolution to CAD
 thiazides, quinidine, quinine or simvastatin


Common photoallergic agents
Topical agents:
 Sunscreens
 Fragrances
 6-Methylcoumarin, Musk ambrette, Sandalwood oil .
 Antimicrobial agents
 Bithionol, Chlorhexidine, Fenticlor, Hexachlorophene
 Nonsteroidal anti-inflammatory drugs
 Diclofenac, Ketoprofen
 Phenothiazines
 Chlorpromazine, Promethazine

Systemic agents ( also toxic):
 Antiarrhythmics
 Quinidine
 Antimalarials
 Quinine
 Antifungals
 Griseofulvin
 Antimicrobials
 Quinolones (e.g. enoxacin,lomefloxacin),Sulfonamides
 Nonsteroidal anti-inflammatory drugs
 Ketoprofen, Piroxicam*

* Often have positive patch test to thimerosal

Photosensitivity23 Photosensitivity24

Photosensitivity25 Photosensitivity26

Photoallergic reaction to HCTZ

Photosensitivity27 Photosensitivity28

Photosensitivity29



Pathology

Phototoxicity

scattered necrotic keratinocytes ('sunburn cells') and a dermal infiltrate of primarily lymphocytes and neutrophils

Photoallergy

Epidermal spongiosis plus a dermal lymphohistiocytic infiltrate, indistinguishable from other spongiotic dermatitis

Photosensitivity30 Photosensitivity31 Photosensitivity32

Pathology

Phototoxicity

scattered necrotic keratinocytes ('sunburn cells') and a dermal infiltrate of primarily lymphocytes and neutrophils

Photoallergy

Epidermal spongiosis plus a dermal lymphohistiocytic infiltrate, indistinguishable from other spongiotic dermatitis

Photosensitivity33 Photosensitivity34
hototoxicity

DDx

 Phototoxicity
 Sunburn
 LE
 Irritant CD
SU
 PLE
 Photoallergy
 airborne contact dermatitis
 Seborrheic dermatitis
 Atopic dermatitis
 Allergic CD
 PLE
 CAD

Treatment

 Identification and avoidance of the offending agent
 If not possible; strict photoprotection (UVB and UVA)
 With evening dosing of a phototoxic drug peak systemic levels occur during the night
 Symptomatic treatment with analgesics, steroids (topical or systemic)

خواندن 2161 دفعه
Image

دکتر محمد ایمانی

متخصص پوست ، مو و زیبایی


پزشک: دکتر ایمانی
پرسشگر: Elmertet
تاریخ: دوشنبه, 05 مهر 1395 09:39
وضعیت: پاسخ داده شده

پرسش:
با سلام و خسته نباشید... جناب دکتر از سن 18سالگی در گیر بیماری ویتیلیگو هستم و بالای 60درصد بدنم رو درگیر کرده ولی رنگ لکه ها خیلی سفید نیست که تابلو باشه ...اولین سوالم اینه که این لکه ها مگه رنگ های سفیده کم رنگ پر رنگ داره؟ چون الان رنگشون مثل رنگ پوسته خیلی سفیده فرد عادیه... و دومین سوالم...آیا حقیقت داره در بیمارستان رازی آمپول هایی وجود داره و تزریق میکنن و پوست سفید میشه؟ هزینه اش چقدره؟ممنون لطفا پاسخ بدید

آقاي ساسان سلام

اگر بيماري در حال پيشرفت باشد،نقاط جديد بدن كه تازه دارند رنگدانه از دست مي دهند ولي هنوز روند پيشرفت ادامه دارد،خيلي سفيد نيستند،در خصوص سوال دوم،چنين آمپول و درماني وجود ندارد،بهترين درمان براي شما نور درماني هست .

 

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