II. Background

  1. Drugs below are Photosensitizers
  2. Skin reactions secondary to Photosensitizers
    1. Hyperpigmentation
    2. Sunburn

III. Signs

  1. Linear or drip pattern of erythema or inflammation
    1. May follow pattern of Photosensitizer contact with skin (e.g. lime or lemon)
  2. Sunburn in well demarcated area (contact with Photosensitizer)
    1. Early
      1. Erythema
      2. Edema
      3. Pain and tenderness
    2. Next
      1. Blistering or bullae
    3. Next
      1. Hyperpigmentation

IV. Management

  1. General measures
    1. Eliminate causative Photosensitizer
    2. Use Sunscreen (see below)
    3. Use cool compresses for comfort
    4. Expect photosensitivity reactions to persist for weeks
  2. Significant inflammation (red, Blistered) management
    1. Topical Corticosteroid
      1. Low potency on the face (e.g. Desonide)
      2. Moderate potency on other areas (e.g. Triamcinolone cream)
      3. High potency agents may be considered on hands (e.g. Clobetasol)
    2. Oral Corticosteroids
      1. May be considered in diffuse reaction

V. Prevention

  1. UVA exposure is associated with photosensitivity
    1. Use both UVA and UVB protection
    2. Use Zinc Oxide, Titanium dioxide, Mexoryl for sun block (esp. covers UVA)

VII. Causes: Cardiovascular Medications

VIII. Causes: Oncology - Antineoplastic medications

  1. Dacarbazine
  2. Fluorouracil
  3. Methotrexate
  4. Vinblastine

IX. Causes: Otolaryngology Medications - Antihistamines

X. Causes: Infectious Disease Medications

  1. Antibiotics
    1. Fluoroquinolones
    2. Ceftazidime
    3. Trimethoprim
    4. Sulfonamides (e.g. Bactrim)
    5. Tetracycline (and related agents)
  2. Antiparasitic Agents
    1. Thiabendazole
    2. Chloroquine
    3. Quinine
  3. Antifungal agents
    1. Griseofulvin
    2. Ketoconazole

XI. Causes: Phytophotodermatitis - Food, herb, or dye exposure

  1. Oils in Perfumes, Cosmetics, Aftershaves, Lipsticks
    1. Bergamot
    2. Citron
    3. Citrus
    4. Lavender
    5. Lime and other psoralens
    6. Vanillin or Vanilla
    7. Sandalwood
    8. Cedar
    9. 6-Methylcoumarin
    10. Musk ambrette
  2. Pigments and Dyes
    1. Acriflavine
    2. Anthraquinone dye (Disperse blue 35)
    3. Eosin
    4. Neutral red
    5. Proflavine
    6. Rivanol
    7. Yellow cadmium sulfide (used in tattooing)
    8. Rose bengal
    9. Methylene blue
    10. Fluorescein
  3. Plant exposures
    1. Furocoumarins
    2. Buttercup
    3. Carrots
    4. Celery
    5. Dill
    6. Fennel
    7. Fig
    8. Lime
    9. Mustard
    10. Parsley
    11. Parsnip
    12. St. John's Wort
    13. Yarrow
    14. Psoralens
    15. Ammi majus
    16. Angelica
    17. Coriander
  4. Food additives
    1. Sulfite additives in food

XII. Causes: Dermatologic and topical medications

  1. Sunscreens
    1. Benzophenones
    2. Para-aminobenzoic Acid (PABA)
    3. Digalloyl Trioleate
  2. Acne Vulgaris Medications
    1. Isotretinoin (Accutane)
    2. Retin A
    3. Benzoyl Peroxide
    4. Etretinate
  3. Alopecia Medications
    1. Minoxidil
  4. Soap Deodorants
    1. Bithionol
    2. Carbanilide
    3. Dichlorophene
    4. Hexachlorophene

XIII. Causes: Endocrine Medications - Oral Hypoglycemics

XIV. Causes: Rheumatologic Medications - NSAIDS

  1. Feldene
  2. Ibuprofen (Motrin)
  3. Naproxen (Naprosyn)
  4. Nabumetone (Relafen)
  5. Indomethacin (Indocin)
  6. Salicylic acids including Aspirin

XV. References

  1. Litt (1997) Drug Eruption Reference Manual
  2. Jhun and DeClerck in Herbert (2016) EM:Rap 16(4): 11-2
  3. Drucker (2011) Drug Saf 34(10): 821-37 [PubMed]
  4. Gould (1995) J Am Acad Dermatol 33:551-73 [PubMed]

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Ontology: Meadow grass dermatitis (C0521480)

Concepts Disease or Syndrome (T047)
SnomedCT 95349002, 44483004, 238521005
English Dermatitis bullosa et striata, Phytophotodermatitis due to topical exposure to furocoumarin, dermatitis bullosa striata pratensis (diagnosis), phytophotodermatitis (diagnosis), phytophotodermatitis, dermatitis bullosa striata pratensis, Phytophotodermatitis, Dermatitis bullosa et striata pratensis, Meadow dermatitis, Plant photodermatitis, Dermatitis bullosa striata pratensis, Meadow grass dermatitis, Phytophlyctodermatitis, Phytophotodermatitis (disorder), Phytophotodermatitis due to topical exposure to furocoumarin (disorder), Phytophotodermatitis, NOS
Dutch fytofotodermatitis
French Phytophotodermatose
German Wiesengraeserdermatitis
Italian Fitofotodermatite
Portuguese Fitofotodermatite
Spanish Fitofotodermatosis, dermatitis ampollosa estriada de las praderas, dermatitis de la hierba de las praderas, dermatitis de la pradera, dermatitis de las praderas (trastorno), dermatitis de las praderas, fitoflictodermatitis, fitofotodermatitis (concepto no activo), fitofotodermatitis (trastorno), fitofotodermatitis, fotodermatitis vegetal
Japanese 植物性光線皮膚炎, ショクブツセイコウセンヒフエン
Czech Fytofotodermatitida
Hungarian Phytophotodermatitis