Phototoxic and photoallergic cutaneous drug reactions

Abstract

A variety of topical and systemic drugs can induce cutaneous photosensitive reactions. These drugs and their metabolites accumulate in the skin and increase photosensitivity of the skin typically in the UVA spectrum of light. Concerning the underlying biochemical mechanisms and the phenotype of reactions, photosensitivity can be divided into phototoxic and photoallergic reactions. In phototoxic reactions, often highly reactive oxygen molecules are formed that induce tissue damage. Skin changes resemble sunburn and develop within hours after incubation with the drug together with sunlight. In contrast, photoallergic reactions are type IV hypersensitivity reactions, and therefore resemble eczema. They usually develop within days and are less common than phototoxic reactions. Diagnosis is based on a synopsis of complete history, clinical examination, phototesting for minimal phototoxicity dose, patch testing including photopatch tests, and histopathology. Mainstays of treatment are the withdrawal of the culprit drug, and avoidance of sunlight by wearing protective clothing and broadband sunscreens with UVA filters.