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Toxicological Research Jun 2015The skin exposure to solar irradiation and photoreactive xenobiotics may produce abnormal skin reaction, phototoxicity. Phototoxicity is an acute light-induced response,... (Review)
Review
The skin exposure to solar irradiation and photoreactive xenobiotics may produce abnormal skin reaction, phototoxicity. Phototoxicity is an acute light-induced response, which occurs when photoreacive chemicals are activated by solar lights and transformed into products cytotoxic against the skin cells. Multifarious symptoms of phototoxicity are identified, skin irritation, erythema, pruritis, and edema that are similar to those of the exaggerated sunburn. Diverse organic chemicals, especially drugs, are known to induce phototoxicity, which is probably from the common possession of UV-absorbing benzene or heterocyclic rings in their molecular structures. Both UVB (290~320 nm) and UVA (320~400 nm) are responsible for the manifestation of phototoxicity. Absorption of photons and absorbed energy (hv) by photoactive chemicals results in molecular changes or generates reactive oxygen species and depending on the way how endogenous molecules are affected by phototoxicants, mechanisms of phototoxcity is categorized into two modes of action: Direct when unstable species from excited state directly react with the endogenous molecules, and indirect when endogeneous molecules react with secondary photoproducts. In order to identify phototoxic potential of a chemical, various test methods have been introduced. Focus is given to animal alternative test methods, i.e., in vitro, and in chemico assays as well as in vivo. 3T3 neutral red uptake assay, erythrocyte photohemolysis test, and phototoxicity test using human 3-dimensional (3D) epidermis model are examples of in vitro assays. In chemico methods evaluate the generation of reactive oxygen species or DNA strand break activity employing plasmid for chemicals, or drugs with phototoxic potential.
PubMed: 26191378
DOI: 10.5487/TR.2015.31.2.097 -
Frontiers in Allergy 2022Drug-induced photosensitivity (DIP) is a common cutaneous adverse drug reaction, resulting from the interaction of ultraviolet radiations, mostly ultraviolet A, with... (Review)
Review
Drug-induced photosensitivity (DIP) is a common cutaneous adverse drug reaction, resulting from the interaction of ultraviolet radiations, mostly ultraviolet A, with drugs. DIP includes phototoxicity and photoallergy. A phototoxic reaction is obtained when topical and systemic drugs or their metabolites absorb light inducing a direct cellular damage, while a photoallergic reaction takes place when the interaction between drugs and ultraviolet radiations causes an immune cutaneous response. Clinically, phototoxicity is immediate and appears as an exaggerated sunburn, whereas photoallergy is a delayed eczematous reaction. DIP may show several clinical subtypes. In this mini-review we report the pathogenetic mechanisms and causative drugs of DIP. We offer a detailed description of DIP clinical features in its classical and unusual subtypes, such as hyperpigmentation/dyschromia, pseudoporphyria, photo-onycolysis, eruptive teleangiectasia, pellagra-like reaction, lichenoid reaction, photodistributed erythema multiforme and subacute/chronic cutaneous lupus erythematosus. We described how physicians may early recognize and manage DIP, including diagnostic tests to rule out similar conditions. We made suggestions on how to improve sun exposure behaviors of patients at risk of DIP by means of an aware use of sunscreens, protective clothing and recent technologic tools. We highlighted the lack of sun safety programs addressed to patients at risk of DIP, who need a formal education about their condition.
PubMed: 36238932
DOI: 10.3389/falgy.2022.876695 -
Cutis May 2019Vandetanib is a once-daily oral multikinase inhibitor that targets the rearranged during transfection (RET) tyrosine kinase, vascular endothelial growth factor receptor,... (Review)
Review
Vandetanib is a once-daily oral multikinase inhibitor that targets the rearranged during transfection (RET) tyrosine kinase, vascular endothelial growth factor receptor, and epidermal growth factor receptor. Among its observed toxicity profile is QT prolongation, diarrhea, and rash, including photosensitivity. This article presents 3 patients with photoinduced cutaneous side effects of vandetanib, including both photoallergic and phototoxic reactions. We review the spectrum of cutaneous photosensitivity reactions and the necessity of histopathologic evaluation to distinguish photoallergic and phototoxic reactions. Given its high prevalence of specifically photoinduced side effects and the variety of the histologic and clinical presentations, reinforcing attentive sun protection could potentially prevent dose reduction or drug cessation in patients treated with vandetanib.
Topics: Aged; Antineoplastic Agents; Dermatitis, Phototoxic; Drug Eruptions; Female; Humans; Male; Middle Aged; Piperidines; Quinazolines
PubMed: 31233590
DOI: No ID Found -
Journal of Dermatological Science Jan 2017Chemical photosensitivity can be elicited by exposure of the skin to various pharmaceutical substances, foods, cosmetics and other environmental chemicals, followed by... (Review)
Review
Chemical photosensitivity can be elicited by exposure of the skin to various pharmaceutical substances, foods, cosmetics and other environmental chemicals, followed by exposure to sunlight. There are at least three types of chemical photosensitivity, i.e., photoirritancy (narrowly defined as phototoxicity), photogenotoxicity and photoallergenicity, and their clinical characteristics and mechanisms are quite different. Concerns about chemical photoallergy is increasing, and various studies have been made to clarify the photobiochemical characteristics of photoallergens and the mechanisms involved. Various methodologies, including in silico prediction models, photochemical assay systems, and in vitro phototoxicity prediction tools, have been developed to predict the photoallergenic potential of chemicals over the past few years. The aim of this manuscript is to review the clinical characteristics, pathogenetic mechanisms and photobiochemical features of photoallergens, with special emphasis on the current status about development of screening systems for predicting photoallergenic potential of chemicals.
Topics: Allergens; Chemically-Induced Disorders; Cosmetics; Dermatitis, Photoallergic; Dermatitis, Phototoxic; Drug-Related Side Effects and Adverse Reactions; Humans; Risk Assessment; Ultraviolet Rays
PubMed: 27528585
DOI: 10.1016/j.jdermsci.2016.08.005 -
Journal of Agricultural and Food... Jun 2015Buckwheat contains many healthy nutrients, and its consumption is therefore increasing. Buckwheat also contains fluorescent phototoxic fagopyrins. A systematic review of... (Review)
Review
Buckwheat contains many healthy nutrients, and its consumption is therefore increasing. Buckwheat also contains fluorescent phototoxic fagopyrins. A systematic review of fagopyrins and the phototoxicity of buckwheat found that reliable quantitative data on fagopyrin toxicity are not yet available. Generally, buckwheat seeds, flour, and teas are safe in normal amounts. Diets extensively composed of buckwheat sprouts, herbs, and particularly flowers or of fagopyrin-rich buckwheat extracts may cause fagopyrism. A reference standard is needed, as it would enable the accurate evaluation of fagopyrin content in buckwheat products and would allow proper testing of their as yet unknown physical, chemical, and biological characteristics.
Topics: Fagopyrum; Flour; Quinones; Seeds
PubMed: 26024291
DOI: 10.1021/acs.jafc.5b01163 -
Expert Review of Anti-infective Therapy 2015Voriconazole's antifungal spectrum, oral bioavailability, and proven efficacy in treatment of invasive mycoses have led to its widespread off-label use for antifungal... (Review)
Review
Voriconazole's antifungal spectrum, oral bioavailability, and proven efficacy in treatment of invasive mycoses have led to its widespread off-label use for antifungal prophylaxis. There is an increasing recognition that long-term voriconazole use is associated with accelerated sun-induced skin changes that include acute phototoxicity reactions, photoaging, actinic keratosis and esp. among immunocompromised patients, skin cancers. The mechanisms underlying these dermatologic adverse events are not clearly understood. Population-risks of long-term voriconazole use need to be prospectively investigated. This review aims to provide an in-depth assessment of published literature and highlight salient findings from retrospective studies and case series. A broad practical guideline for assessment and management of these patients is provided.
Topics: Animals; Antifungal Agents; Dermatitis, Phototoxic; Humans; Skin Neoplasms; Voriconazole
PubMed: 26488688
DOI: 10.1586/14787210.2015.1102053 -
Dermatology Online Journal Jul 2021
Topics: Aged; Dermatitis, Phototoxic; Hand Dermatoses; Humans; Male; Ruta
PubMed: 34391344
DOI: 10.5070/D327754382 -
Journal of the American Academy of... Dec 2018Phototoxicity has been attributed to numerous oral drugs over the past 60 years.
BACKGROUND
Phototoxicity has been attributed to numerous oral drugs over the past 60 years.
OBJECTIVE
Determine the quality of evidence supporting suspected phototoxicity from oral drugs.
METHODS
The MEDLINE and EMBASE databases were searched for all studies that contain original data for drug-induced phototoxicity and were published between May 1959 and December 2016. Study quality was assessed by using a modified Grading of Recommendations, Assessment, Development and Evaluation scale.
RESULTS
The review included 240 eligible studies with a total of 2466 subjects. There were 1134 cases of suspected phototoxicity associated with 129 drugs. Most associations were supported by either very low-quality or low-quality evidence (89.1% of the studies). Medications supported by stronger evidence were vemurafenib, nonsteroidal anti-inflammatory drugs, and antibiotics, specifically, fluoroquinolones and tetracyclines. The most frequently reported drugs were vemurafenib, voriconazole, doxycycline, hydrochlorothiazide, amiodarone, and chlorpromazine. Photobiologic evaluation was performed in only 56 studies (23.3%), whereas challenge-rechallenge was done in 10% of cases.
LIMITATIONS
Only English-language publications were reviewed. Cases of phototoxicity that had been incorrectly categorized as photoallergy would not have been included.
CONCLUSIONS
Most purported associations between oral drugs and phototoxicity are not supported by high-quality evidence. Despite the variable quality of data, clinicians should be aware of the possible consequences of long-term use of culprit drugs.
Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Dermatitis, Phototoxic; Evidence-Based Medicine; Humans; Vemurafenib
PubMed: 30003982
DOI: 10.1016/j.jaad.2018.06.061 -
Journal of the European Academy of... May 2015Onycholysis - the separation of the nail plate from the nail bed occurs in fingers and toenails. It is diagnosed by the whitish appearance of the separated nail plate... (Review)
Review
Onycholysis - the separation of the nail plate from the nail bed occurs in fingers and toenails. It is diagnosed by the whitish appearance of the separated nail plate from the nail bed. In fingers, the majority is caused by trauma, manicuring, occupational or self-induced behavior. The most common disease producing fingernail onycholysis is psoriasis and pustular psoriasis. Phototoxic dermatitis, due to drugs can also produce finger onycholysis. Once the separation occurs, the environmental flora sets up temporary colonization in the available space. Finger onycholysis is most common in women. Candida albicans is often recovered from the onycholytic space. Many reports, want to associate the yeast as cause and effect, but the data are lacking and the treatment of the candida does not improve finger onycholysis. A reasonable explanation for the frequent isolation of Candida and Pseudomonas in fingernail onycholysis in women, is the close proximity the fingers have to the vaginal and gastrointestinal tract. Fifty per cent of humans harbour C. albicans in the GI tract and it is frequently carried to the vagina during hygienic practices. Finger onycholysis is best treated by drying the nail 'lytic' area with a hair blower, since all colonizing biota are moisture loving and perish in a dry environment. Toenail onycholysis has a very different etiology. It is mechanical, the result of pressure on the toes from the closed shoes, while walking, because of the ubiquitous uneven flat feet producing an asymmetric gait with more pressure on the foot with the flatter sole.
Topics: Fingers; Foot Dermatoses; Hand Dermatoses; Humans; Onycholysis; Onychomycosis; Toes
PubMed: 25512134
DOI: 10.1111/jdv.12862 -
American Journal of Clinical Dermatology Apr 2016Afamelanotide (SCENESSE(®)) is a synthetic α-melanocyte stimulating hormone analogue and first-in-class melanocortin-1 receptor agonist that is approved in the EU for... (Review)
Review
Afamelanotide (SCENESSE(®)) is a synthetic α-melanocyte stimulating hormone analogue and first-in-class melanocortin-1 receptor agonist that is approved in the EU for the prevention of phototoxicity in adults with erythropoietic protoporphyria (EPP). It is administered subcutaneously as a biodegradable, controlled-release implant containing 16 mg of afamelanotide. This article reviews the clinical efficacy and tolerability of afamelanotide in EPP and summarizes its pharmacological properties. In the phase III trial, CUV039, afamelanotide treatment improved light tolerance in patients with EPP. Compared with placebo, afamelanotide treatment enabled patients to spend more time in direct sunlight without pain and increased the time to the appearance of the first symptoms of phototoxicity provoked by a standardized light source. Afamelanotide was generally well tolerated in this trial, with no drug-related serious adverse events reported. Commonly occurring adverse reactions included headache and implant-site reactions. Efficacy and safety data from earlier phase III trials are consistent with those from the CUV039 trial. Afamelanotide, approved in the EU for the prevention of EPP phototoxicity, represents a useful addition to the management of the disorder.
Topics: Absorbable Implants; Adult; Clinical Trials, Phase III as Topic; Dermatitis, Phototoxic; Drug Implants; European Union; Headache; Humans; Protoporphyria, Erythropoietic; Receptor, Melanocortin, Type 1; Subcutaneous Absorption; Sunlight; Treatment Outcome; alpha-MSH
PubMed: 26979527
DOI: 10.1007/s40257-016-0184-6