What is Photosensitivity?
Certain medications can cause increased sun sensitivity (photosensitivity). Increased photosensitivity increases the likely hood of the sun damaging the skin, causing inflammation, redness, and swelling of the skin and is similar to a sunburn.
There are two types of drug induced photosensitivity reactions. The first is phototoxicity, which is a chemical induced reaction that occurs when a drug is activated by UVR (usually UVA since it penetrates deeper into the skin) from the sun. It has a fast onset and will usually clear up once the drug is discontinued. A photoallergy occurs when the sun changes the structure of drug and the immune system recognizes the drug as a foreign invader, leading to inflammation of the skin. Photoallergies are uncommon and may occur even after the drug has been discontinued and can spread to all areas of the skin.
Common Drugs that Cause Sunburn
Antibiotics are used to treat bacterial infections because they either inhibit the growth of the bacteria and prevent them from spreading or kill the bacteria completely.
- Examples include ciprofloxacin (Cipro), levofloxacin (Levaquin)
- Used for treating many types of infections.
- trimethoprim- sulfamethoxazole (Bactrim, Septra)
- Commonly used to treat urinary and respiratory tract infections and is associated with both mild and severe allergic reactions.
- doxycycline (Vibramycin, Oracea, Adoxa, Doryx), minocycline (Minocin, Dynacin), tetracycline (Achromycin)
- Used for treating acne, chlamydia, and respiratory tract infections.
Antiarrhythmics (Cardiac drugs)
These drugs are used to treat irregular heartbeats such as atrial or ventricular fibrillation
- amiodarone (Cordarone): Used for treating ventricular and atrial arrhythmias.
- quinidine (Quinidex): Used for malaria, psuedobulbar affect, and rarely used for ventricular or atrial arrhythmias.
These drugs are used in the treatment of hypertension, heart failure or edema.
- furosemide (Lasix): This is a loop diuretic approved for treating edema, heart failure, hypertension, hypermagnesemia (increased magnesium), hyperkalemia (increased potassium).
- hydrochlorothiazide (Microzide, Hydrodiuril): Thiazides are most often used for hypertension in combination with other drugs. They are also used for treating edema.
NSAID (non-steroidal anti-inflammatory)
These are “pain killers” that are commonly used to treat pains such as headaches, muscle aches, fevers and inflammation. They should all be taken with food since they can cause abdominal discomfort.
- naproxen (Naprosyn, Aleve, Anaprox)
- ibuprofen (Advil, Motrin)
- ketoprofen (Orudis)
These are oral retinoids that are used to treat severe nodular and cystic acne that hasn’t responded to other conventional acne treatments.
- isotretinoin (Accutane, Amnesteem, Claravis, Sotret): Causes birth defects and both pharmacies and patients must register and be active in the iPLEDGE risk evaluation and mitigation strategy (REMS) program.
- acitretin (Soriatane): Should not be used by women who are pregnant or want to become pregnant. The Do Your P.A.R.T. (Pregnancy Prevention Actively Required During and After Treatment) program explains all the risks and requirements that needs to be fulfilled.
Here are examples of topical retinoids that can be used to treat both acne and photoaging.
- tazarotene (Tazorac, Avage, Zorac)
- tretinoin (Retin-A, Renova)
Antidepressants and Antipsychotics
Antidepressants are used for treating depression. Antipsychotics are used for treating bipolar disorder or schizophrenia.
- desipramine (Norpramin), imipramine (Tofranil)
- Common side effects include dry mouth, blurry vision, urinary retention, constipation and memory impairment.
- chlorpromazine (Thorazine)
- Common side effects include sedation and slurred speech.
Anti-neoplastic (Cancer Chemotherapy drugs)
Chemotherapy is used in the treatment of cancer and often may require more than one drug as part of a standardized treatment regimen.
- 5-Flurouracil (5-FU, Efudex, Carac, Fluroplex)
How to Prevent Drug Induced Photosensitivity
Avoid excessive sunlight by taking precautions to limit sun exposure while taking these medications. Some precautions include wearing loose fitting clothing that covers the entire body if possible and using a broad spectrum sunscreen. Also avoid the use of tanning products during this time. These medications may lead to mild to severe phototoxicity reactions which may appear as exaggerated sunburn reactions. Contact your physician or pharmacist if photoxicity occurs.
Hawk JLM, Norris PG, Hönigsmann H. Abnormal responses to ultraviolet radiation: idiopathic, probably immunologic, and photoexacerbated. In: Freedberg IM, Eisen AZ, Wolff K, et al., eds. Fitzpatrick's Dermatology in General Medicine. 6th ed. New York, NY: McGraw-Hill, Inc.; 2003:1283-98.
Lexicomp Online, Lexi-Drugs Online, Hudson, Ohio: Lexi-Comp, Inc.; 2013
Sarnoff DS, Saini R., Handel A. Photosensitivity. Skin Cancer Foundation .2010.
PL Detail-Document, Drugs that Increase Photosensitivity. Pharmacist’s Letter/Prescriber’s Letter. July 2012.