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Drugs & Diseases > Dermatology

Drug-Induced Photosensitivity
Updated: Jun 15, 2017
Author: Alexandra Y Zhang, MD; Chief Editor: Dirk M Elston, MD more...

Background
Drug-induced photosensitivity refers to the development of cutaneous disease as a
result of the combined effects of a chemical and light. [1] Exposure to either the
chemical or the light alone is not sufficient to induce the disease; however, when
photoactivation of the chemical occurs, one or more cutaneous manifestations may
arise. These include phototoxic and photoallergic reactions, a planus lichenoides
reaction, pseudoporphyria, and subacute cutaneous lupus erythematosus.
Photosensitivity reactions may result from systemic medications and topically
applied compounds (see Table 1 below).
UV-Aassociated phototoxicity is also common with vemurafenib, [2, 3, 4] with
reduced UV-A minimal erythema dose in 94% of those tested. [2]
Wavelengths within the UV-A (320-400 nm) range and, for certain compounds,
within the visible range, are more likely to cause drug-induced photosensitivity
reactions, although occasionally UV-B (290-320 nm) can also be responsible for
such effects. UV-B wavelengths are most efficient at causing sunburn and
nonmelanoma skin cancer. In patients who present with photosensitivity, it is often
difficult to differentiate phototoxic from photoallergic reactions. However, they
have a number of distinguishing characteristics (see Table 2 below).
Table 1. Common Photosensitizing Medications (Open Table in a new window)
Photo- Photo- Subacute
Lichenoid Pseudo-
Class Medication toxic allergic Cutaneous Lupus
Reaction porphyria
Reaction Reaction Erythematosus

Tetracyclines (doxycycline,
Antibiotics Yes No Yes Yes No
tetracycline)

Fluoroquinolones
(ciprofloxacin, ofloxacin, Yes No No No No
levofloxacin) [5]

Sulfonamides Yes No No No No
Nonsteroidal anti-
Ibuprofen Yes No Yes No No
inflammatory drugs [6]

Ketoprofen [7] Yes Yes No No No

Naproxen [8] Yes No Yes Yes No

Celecoxib [9] 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

Acitretin Yes No No No No

Hypoglycemics Sulfonylureas (glipizide, glyburide) [5] No Yes Yes Yes No

HMG-CoA* reductase Statins (atorvastatin, fluvastatin,

Yes Yes Yes Yes No
inhibitors lovastatin, pravastatin, simvastatin) [10]

Epidermal growth factor Cetuximab, panitumumab, erlotinib,

Yes Yes Yes Yes No
receptor inhibitors gefitinib, lapatinib, vandetanib [11]

BRAF inhibitors Vemurafenib, [2, 3, 4] sorafenib Yes No No No Yes

Photodynamic therapy
5-Aminolevulinic acid [12] Yes No No No No
prophoto-sensitizers

Methyl-5-aminolevulinic acid Yes No No No No

Verteporfin [13] Yes No No No No

Photofrin [14] Yes No No No No

Phenothiazines (chlorpromazine,
Neuroleptic drugs [15] fluphenazine, perazine, perphenazine, Yes Yes Yes No No
thioridazine) [16]

Thioxanthenes
Yes No No No No
(chlorprothixene, thiothixene)

Antifungals Terbinafine No No No No Yes

Itraconazole Yes Yes No No No

Voriconazole [17, 18, 19, 20] 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 [6, 21] 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 [22, 23] No Yes No Yes No

Sunscreens [24] 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

6-Methylcoumarin No Yes No No No

*3-Hydroxy-3-methylglutaryl
coenzyme A.

Phototoxic reactions occur because of the damaging effects of light-activated

compounds on cell membranes and, in some instances, DNA. By contrast,
photoallergic reactions are cell-mediated immune responses to a light-activated
compound. Phototoxic reactions develop in most individuals if they are exposed to
sufficient amounts of light and drug. Typically, they appear as an exaggerated
sunburn response, as shown in the image below.
 Phototoxic reaction.
View Media Gallery
Photoallergic reactions resemble allergic contact dermatitis, with a distribution
limited to sun-exposed areas of the body. However, when the reactions are severe
or prolonged, they may extend into covered areas of skin.
Table 2. Distinguishing Characteristics of Phototoxic and Photoallergic
Reactions(Open Table in a new window)
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

Photoallergic reactions develop in only a minority of individuals exposed to the

compound and light; they are less prevalent than phototoxic skin reactions. The
amount of drug required to elicit photoallergic reactions is considerably smaller
than that required for phototoxic reactions. Moreover, photoallergic reactions, as
shown in the image below, are a form of cell-mediated immunity; their onset often
is delayed by as long as 24-72 hours after exposure to the drug and light. By
 contrast, phototoxic responses often occur within minutes or hours of light
exposure.

Photoallergic reaction.
View Media Gallery
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