Phototoxic reactions

Hazardous tasks Quinolones may cause dizziness and light-headedness. Patients should know how they react to nalidixic acid before they operate an automobile or machinery or engage in activities requiring mental alertness or coordination. Photosensitivity Moderate to severe phototoxicity reactions have been observed in patients who are exposed to direct sunlight while receiving nalidixic acid or other members of this drug class. Avoid excessive sunlight. Discontinue therapy if phototoxicity occurs. 

Phototoxicity Moderate-to-severe phototoxic reactions have occurred in patients exposed to direct or indirect sunlight or to artificial ultraviolet light (eg, sunlamps) during or following treatment with lomefloxacin, sparfloxacin, or ofloxacin. 

Phototoxic reactions are most frequent with demeclocycline, and occur less frequently with the other tetracyclines minocycline is least likely to cause phototoxic reactions. 

Numerous glucocorticosteroids for topical application are available. Essentially they all suppress the symptoms of inflammatory and hypersensitivity reactions and their mechanism of action is similar. Their indications include seborrhoeic and atopic dermatitis, phototoxic reactions, psoriasis, chronic discoid lupus, hypertrophic lichen planus and alopecia areata. However it has to be kept in mind that the use of corticosteroids for these conditions in most cases only gives symptomatic relieve and that the problem tends to recur on cessation of therapy. Traditionally topical corticosteroid formulations are grouped according to approximate relative efficacy. This efficacy is determined by both the potency of the agent and the concentration in which the corticosteroid is used. 

DC220 Ratka, P., and T. Sloboda. Phototoxic reaction from vegetables. Contact... 

St. John s wort 5-Aminolevulinic acid A phototoxic reaction occurred in a patient... 

Phototoxicity Use should be limited to 20% as the expressed oil causes phototoxic reaction in sunlight... 

A rare case of skin hyperpigmentation (apparently a phototoxic reaction) has been associated with sulfasalazine lung (93). 

Amiodarone commonly causes phototoxicity reactions (186,187). The risk of phototoxicity increases with the duration of the exposure. Window glass and sun screens do not give protection, although zinc or titanium oxide formulations and narrow band UVB photo therapy can help (188-190). For most patients this adverse effect will be no more than a nuisance, and the benefit of therapy may be worthwhile. However, in a few cases treatment may have to be withdrawn. Histological examination of skin biopsies shows intracytoplasmic inclusions of phospholipids (191). There has been a single report of a severe case of photosensitivity in conjunction with a syndrome resembling porphyria cutanea tarda, resulting in bullous lesions (192). 

Parkash P, Gupta SK, Kumar S. Phototoxic reaction due to clarithromycin. J Assoc Physicians India 2002 50 1192-3. 

An Australian dermatologist has reported three cases of phototoxic reactions to St. John s wort (14). The patients were fair-skinned and had had significant exposure to ultraviolet light. In two cases St. John s wort was applied topically. In all cases complete recovery occurred after withdrawal of St. John s wort and cessation of exposure to ultraviolet light. 

Phototoxic reactions occurred in 10 patients with malignant melanoma when they were given dacarbazine (6). In five patients who were tested there was increased sensitivity to ultraviolet A patch-testing in six showed no type IV allergies. In five patients oral temozolomide did not cause phototoxicity. 

Moxifloxacin has a low propensity for causing phototoxic reactions relative to other fluoroquinolones (2,3). 

Phototoxic reactions occur in animals given nalidixic acid after exposure to light (20) and have been reported in patients taking nalidixic acid, with blistering (21,22). Sometimes the lesions develop only several days after nalidixic acid withdrawal. The eruptions can persist for several months after withdrawal. 

Zelickson AS. Phototoxic reaction with nalidixic acid. JAMA 1964 190 556-7. 

Under 5% of patients taking oxaprozin develop rashes. Some have phototoxic reactions (SEDA-12, 87). 

A 51-year-old woman developed erythema and swelling on sun-exposed areas and complained of a local burning sensation and pruritus 10 days after she started to take rilmenidine 1 mg/day for mild hypertension. She recovered fully 1 week after rilmenidine withdrawal and treatment with prednisolone. The chronology and the results of patch and photopatch tests suggested a phototoxic reaction to rilmenidine. 

The essential oil of rue can cause contact dermatitis and phototoxic reactions (31,32) and severe hepatic and renal... 

Kaddu S, Kerl H, Wolf P. Accidental bullous phototoxic reactions to bergamot aromatherapy oil. J Am Acad Dermatol 2001 45(3) 458-61. 

During the first 9 months of marketing of sparfloxacin, 371 severe phototoxic reactions were reported to the French pharmacovigilance system or the manufacturers, reporting rate of 0.4 per thousand treated patients (about 4—25 times that reported with other fluoroquinolones) (15). 

In 25 patients taking sparfloxacin for multidrug-resistant tuberculosis, there were five mild phototoxic reactions (12). 

Kang JS, Kim TH, Park KB. Hydrochlorothiazide-induced phototoxic reaction. Korean J Dermatol 1992 30 529-34. 

In animal study it was reported that 89% of the mice fed PPD developed lenticular changes indicating that PPD has cataractogenous effects, which are related to the duration, amount and individual sensitivity [49]. It was concluded that PPD is potentially toxic to human lens. Exophthalmia and permanent blindness due to optic nerve atrophy following PPD poisoning were reported [6]. Using a patch test to determine PPD phototoxicity, it was proved that PPD could cause a phototoxic reaction and photoallergy [50- 51]. 

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