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Oxford Medical Case Reports Nov 2019Phytophotodermatitis, also commonly known as phototoxic dermatitis, is a common skin condition that occurs after contact with certain plants and subsequent exposure to...
Phytophotodermatitis, also commonly known as phototoxic dermatitis, is a common skin condition that occurs after contact with certain plants and subsequent exposure to sunlight. It is often confused with skin burns due to the blistering nature of its lesions. We herein report a case of phytophotodermatitis that developed in a 26-year-old male following contact with lime and subsequent exposure to sunlight.
PubMed: 31844529
DOI: 10.1093/omcr/omz113 -
Yakugaku Zasshi : Journal of the... 2021Phototoxicity is a toxic response elicited by topically applied or systemically administered photoreactive chemicals after exposure to light and can be broadly... (Review)
Review
Phototoxicity is a toxic response elicited by topically applied or systemically administered photoreactive chemicals after exposure to light and can be broadly categorized into photoirritation, photoallergy, photogenotoxicity, and photocarcinogenicity. The need in the 21st century for accurate evaluation of photosafety has led to the publication of a number of guidelines from government agencies in Europe and the U.S.A. as well as the Organisation for Economic Co-operation and Development (OECD). In this review, we first discuss the mechanisms of phototoxicity and how they can be evaluated. We then discuss the state of the art and challenges now faced in photosafety evaluation of pharmaceuticals and cosmetics. Additionally, we describe the latest developments in OECD test guidelines (TG) for assessing photosafety, including revisions to the in vitro 3T3 neutral red uptake (NRU) phototoxicity test (TG 432) and the newly adopted reactive oxigen species (ROS) assay (TG 495). We will emphasize the importance of selecting the most appropriate means of evaluation with reference to the latest guidelines and other legal criteria for conducting photosafety evaluation.
Topics: 3T3 Cells; Animals; Cells, Cultured; Dermatitis, Phototoxic; Humans; Light; Mice; Neutral Red; Reactive Oxygen Species; Safety; Toxicity Tests
PubMed: 33390438
DOI: 10.1248/yakushi.20-00148 -
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 -
Molecular Genetics and Metabolism Nov 2019Congenital erythropoietic porphyria (CEP) is a rare autosomal recessive disorder characterized by photosensitivity and by hematologic abnormalities in affected... (Review)
Review
Congenital erythropoietic porphyria (CEP) is a rare autosomal recessive disorder characterized by photosensitivity and by hematologic abnormalities in affected individuals. CEP is caused by mutations in the uroporphyrinogen synthase (UROS) gene. In three reported cases, CEP has been associated with a specific X-linked GATA1 mutation. Disease-causing mutations in either gene result in absent or markedly reduced UROS enzymatic activity. This in turn leads to the accumulation of the non-physiologic and photoreactive porphyrinogens, uroporphyrinogen I and coproporphyrinogen I, which damage erythrocytes and elicit a phototoxic reaction upon light exposure. The clinical spectrum of CEP depends on the level of residual UROS activity, which is determined by the underlying pathogenic loss-of-function UROS mutations. Disease severity ranges from non-immune hydrops fetalis in utero to late-onset disease with only mild cutaneous involvement. The clinical characteristics of CEP include exquisite photosensitivity to visible light resulting in bullous vesicular lesions which, when infected lead to progressive photomutilation of sun-exposed areas such as the face and hands. In addition, patients have erythrodontia (brownish discoloration of teeth) and can develop corneal scarring. Chronic transfusion-dependent hemolytic anemia is common and leads to bone marrow hyperplasia, which further increases porphyrin production. Management of CEP consists of strict avoidance of exposure to visible light with sun-protective clothing, sunglasses, and car and home window filters. Adequate care of ruptured vesicles and use of topical antibiotics is indicated to prevent superinfections and osteolysis. In patients with symptomatic hemolytic anemia, frequent erythrocyte cell transfusions may be necessary to suppress hematopoiesis and decrease marrow production of the phototoxic porphyrins. In severe transfection-dependent cases, bone marrow or hematopoietic stem cell transplantation has been performed, which is curative. Therapeutic approaches including gene therapy, proteasome inhibition, and pharmacologic chaperones are under investigation.
Topics: Animals; Biosynthetic Pathways; GATA1 Transcription Factor; Genetic Diseases, Inborn; Genetic Therapy; Heme; Humans; Mice; Mutation; Porphyria, Erythropoietic
PubMed: 30685241
DOI: 10.1016/j.ymgme.2018.12.008 -
Dermatology Online Journal Feb 2011Voriconazole is an extended-spectrum triazole antifungal approved for treatment of invasive fungal infections. The drug has been associated with phototoxicity,...
Voriconazole is an extended-spectrum triazole antifungal approved for treatment of invasive fungal infections. The drug has been associated with phototoxicity, presenting as photodistributed eruptions such as macular erythema or pseudoporphyria. We describe a 59-year-old man with acute myeloid leukemia, status-post matched unrelated donor stem cell transplant, who developed fungal pneumonia and was placed on posaconazole. The patient had difficulty complying with the four-times daily dosing and was switched to voriconazole 200 mg twice daily. Soon after, the patient began working outside and subsequently developed photodistributed, macular erythema of the head, neck, and upper chest. Melanoma and squamous cell carcinoma have developed in patients with chronic treatment with voriconazole. Strict adherence to photoprotective measures can prevent the side effect of phototoxic eruption or prevent recurrence in patients who develop this adverse reaction without having to discontinue voriconazole.
Topics: Antifungal Agents; Bone Marrow Transplantation; Dermatitis, Phototoxic; Humans; Leukemia, Myeloid, Acute; Lung Diseases, Fungal; Male; Middle Aged; Pyrimidines; Sunlight; Triazoles; Voriconazole
PubMed: 21382298
DOI: No ID Found -
Medicina (Kaunas, Lithuania) 2006Photosensitive skin reactions occur when human skin reacts to ultraviolet radiation or visible light abnormally. The forms of photosensitivity are phototoxicity and... (Comparative Study)
Comparative Study Review
Photosensitive skin reactions occur when human skin reacts to ultraviolet radiation or visible light abnormally. The forms of photosensitivity are phototoxicity and photoallergy. Phototoxic disorders have a high incidence, whereas photoallergic reactions are much less frequent in human population. Several hundred substances, chemicals, or drugs may invoke phototoxic and photoallergic reactions. In order to avoid photosensitive reactions it is essential to determine the photosensitizing properties of such substances before drugs are introduced in therapy or products made available on the market. The article reviews the mechanisms of photosensitization, explains the most important differences between phototoxic and photoallergic reactions, summarizes the most common photosensitizers, and presents the clinical features and diagnostic procedures of phototoxic and photoallergic reactions.
Topics: Adult; Child; Dermatitis, Photoallergic; Dermatitis, Phototoxic; Diagnosis, Differential; Drug-Related Side Effects and Adverse Reactions; Humans; Photosensitivity Disorders; Skin Tests; Sunburn; Sunscreening Agents
PubMed: 16963827
DOI: No ID Found -
Orphanet Journal of Rare Diseases Sep 2009Erythropoietic protoporphyria (EPP) is an inherited disorder of the haem metabolic pathway characterised by accumulation of protoporphyrin in blood, erythrocytes and... (Review)
Review
Erythropoietic protoporphyria (EPP) is an inherited disorder of the haem metabolic pathway characterised by accumulation of protoporphyrin in blood, erythrocytes and tissues, and cutaneous manifestations of photosensitivity. EPP has been reported worldwide, with prevalence between 1:75,000 and 1:200,000. It usually manifests in early infancy upon the first sun exposures. EPP is characterised by cutaneous manifestations of acute painful photosensitivity with erythema and oedema, sometimes with petechiae, together with stinging and burning sensations upon exposure to sunlight, without blisters. These episodes have a variable severity depending on the exposure duration and may result in chronic permanent lesions on exposed skin. As protoporphyrin is a lipophilic molecule that is excreted by the liver, EPP patients are at risk of cholelithiasis with obstructive episodes, and chronic liver disease that might evolve to rapid acute liver failure. In most patients, EPP results from a partial deficiency of the last enzyme of the haem biosynthetic pathway, ferrochelatase, EC 4.99.1.1/FECH (encoded by the FECH gene). EPP appears to be inherited as an autosomal dominant disease, the clinical expression of which is modulated by the presence of the hypomorphic FECH IVS3-48C allele trans, but recessive inheritance with two mutated FECH alleles has also been described. In about 2% of patients, overt disease was recently shown to be caused by gain-of-function mutations in the erythroid-specific aminolevulinic acid synthase 2 (ALAS2/ALAS, EC 2.3.1.27) gene and named X-linked dominant protoporphyria. Diagnosis is established by finding increased levels of protoporphyrin in plasma and red blood cells, and detection of a plasma fluorescence peak at 634 nm. Investigations for hepatic involvement, ferrochelatase activity level, genetic analysis (FECH mutations, presence of the hypomorphic FECH IVS3-48C allele trans and ALAS2 mutations) and family studies are advisable. Differential diagnosis includes phototoxic drug reactions, hydroa vacciniforme, solar urticaria, contact dermatitis, angio-oedema and, in some cases, other types of porphyria. Management includes avoidance of exposure to light, reduction of protoporphyrin levels and prevention of progression of possible liver disease to liver failure. As the major risk in EPP patients is liver disease, a regular follow-up of hepatic involvement is essential. Sequential hepatic and bone marrow transplantation should be considered as a suitable treatment for most severe cases of EPP with hepatic involvement. EPP is a lifelong disorder whose prognosis depends on the evolution of the hepatic disease. However, photosensitivity may have a significant impact on quality of life of EPP patients.
Topics: Ferrochelatase; Humans; Photosensitivity Disorders; Protoporphyria, Erythropoietic
PubMed: 19744342
DOI: 10.1186/1750-1172-4-19 -
The Japanese Dental Science Review Nov 2018In dentistry, blue light is widely used for tooth bleaching and restoration procedures involving composite resin. In addition, many dentists use magnification loupes to... (Review)
Review
In dentistry, blue light is widely used for tooth bleaching and restoration procedures involving composite resin. In addition, many dentists use magnification loupes to enable them to provide more accurate dental treatment. Therefore, the use of light is indispensable in dental treatment. However, light can cause various toxicities, and thermal injuries caused by light irradiation are regarded as particularly important. In recent years, the eye damage and non-thermal injuries caused by blue light, the so-called "blue light hazard", have gained attention. Unfortunately, much of the research in this field has just begun, but our recent findings demonstrated that blue-light irradiation generates reactive oxygen species (ROS) and induces oxidative stress in oral tissue. However, they also showed that such oxidative stress is inhibited by antioxidants. There have not been any reports that suggested that the ROS-induced phototoxicity associated with blue-light irradiation causes direct clinical damage, but some disorders are caused by the accumulation of ROS. Therefore, it is presumed that it is necessary to suppress the accumulation of oxidative stressors in oral tissues during treatment. In the future, we have to promote discussion about the suppression of phototoxicity in dentistry, including concerning the use of antioxidants to protect against phototoxic damage.
PubMed: 30302134
DOI: 10.1016/j.jdsr.2018.06.002 -
Dermatology Online Journal Jul 2021
Topics: Aged; Dermatitis, Phototoxic; Hand Dermatoses; Humans; Male; Ruta
PubMed: 34391344
DOI: 10.5070/D327754382