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Drugs That Cause Sun-Related Skin Reactions

Worst Pills, Best Pills Newsletter article July, 2016

Summer is a terrific time for healthy outdoor activities, such as walking, hiking, biking and swimming. Most people do not stop to think about how the drugs in their medicine cabinet might put a damper on their summer fun. Yet for an unlucky few, certain medicines can lead to very uncomfortable consequences when used before time in the sun.

Some drug ingredients can cause cases of photosensitivity — a chemically induced change in the skin that makes a person more sensitive to sunlight[1]...

Summer is a terrific time for healthy outdoor activities, such as walking, hiking, biking and swimming. Most people do not stop to think about how the drugs in their medicine cabinet might put a damper on their summer fun. Yet for an unlucky few, certain medicines can lead to very uncomfortable consequences when used before time in the sun.

Some drug ingredients can cause cases of photosensitivity — a chemically induced change in the skin that makes a person more sensitive to sunlight[1] — resulting in sunburn-like symptoms, rash or other, more serious skin-related side effects.[2] The problems can occur with products applied to the skin, as well as with medicines that are swallowed or injected.[3]

In most cases, skin symptoms caused by drug-induced photosensitivity occur within a few hours of exposure to sunshine or artificial ultraviolet (UV) light, such as light from a tanning booth. This type of reaction is called phototoxicity.[4]

Less commonly, a patient will develop a drug-induced allergic reaction to sunshine, called photoallergy. In cases of photoallergy, symptoms may not begin until several days after sun exposure. A dermatologist can diagnose photoallergy using a patch test in which areas of skin are exposed to suspected drug ingredients and light in an attempt to trigger a reaction.[5]

Many types of medicines can cause photosensitivity, including commonly used over-the-counter drugs. Non-steroidal anti-inflammatory drugs, including ibuprofen (ADVIL) and naproxen (ALEVE) are among the over-the-counter drugs that can cause this reaction. (See table, below, for a longer list of examples).[6]

Some cosmetic products also can cause photosensitivity. For example, certain products sold for treating wrinkles or unblocking pores contain alpha hydroxy acids, chemicals that cause the skin to shed or peel, and can also cause increased sensitivity to UV rays. The FDA, which regulates cosmetics poorly, has recommended (but does not require) that all cosmetic products containing alpha hydroxy acids be labeled with a “sunburn alert” statement warning consumers that the product increases the risk of sunburn, which can persist for up to a week after using it.[7]

Examples of Drugs That Cause Photosensitivity

Drug Family Examples
Antiarrhythmic drugs
  • amiodarone (CORDARONE, PACERONE)
  • flecainide (generic only)
  • quinidine (generic only)
Antibiotics
  • ciprofloxacin (CIPRO)*
  • doxycycline (ACTICLATE, DORYX, DOXTERIC, DOXY, MONODOX, ORACEA, VIBRAMYCIN)*
  • levofloxacin (LEVAQUIN)*
  • ofloxacin (available in generic only)*
  • sulfamethoxazole-trimethoprim (BACTRIM, SEPTRA, SULFATRIM PEDIATRIC)
  • tetracycline (ACHROMYCIN V)*
Antifungals
  • flucytosine (ANCOBON)
  • griseofulvin (GRIS-PEG)
Antihistamines
  • cetirizine (ZYRTEC)
  • cyproheptadine (available in generic only)
  • diphenhydramine (BENADRYL, among other brands)
  • loratadine (ALAVERT, CLARITIN, CLARINEX)*
Anti-hypertensive drugs Calcium channel blockers:
  • diltiazem (CARDIZEM, CARTIA XT, DILTZAC, TAZTIA XT, TIAZAC)
  • nifedipine (ADALAT CC, AFEDITAB CR, PROCARDIA)
Thiazide diuretics:
  • chlorthalidone (available in generic only)
  • chlorothiazide (DIURIL)
  • hydrochlorothiazide (MICROZIDE)*
Other diuretics:
  • furosemide (LASIX)*
  • triamterene (DYAZIDE, DYRENIUM, MAXZIDE)**
Antimalarials
  • chloroquine (ARALEN)
  • hydroxychloroquine (PLAQUENIL)
  • quinine (QUALAQUIN)
Cholesterol-lowering drugs
  • atorvastatin (LIPITOR)
  • lovastatin (ALTOPREV)
  • pravastatin (PRAVACHOL)
  • simvastatin (ZOCOR)
Non-steroidal anti-inflammatory drugs
  • celecoxib (CELEBREX)**
  • ibuprofen (ADVIL, among other brands)
  • ketoprofen (available in generic only)
  • naproxen (ALEVE, ANAPROX, NAPRELAN, NAPROSYN)
  • piroxicam (FELDENE)**
Oral contraceptives and estrogens
  • conjugated estrogens (PREMARIN, among other brands)
  • estradiol (ALORA, DIVIGEL, among other brands)
  • levonorgestrel and ethinyl estradiol (ALTAVERA, AVIANE, ENPRESSE, LESSINA, LEVORA, LOSEASONIQUE, ORSYTHIA, PORTIA, QUARTETTE, QUASENSE, SEASONALE, SEASONIQUE, TRIVORA)
  • norethindrone and ethinyl estradiol (COMBI PATCH, LOESTRIN, among other brands)
  • norgestimate and ethinyl estradiol (ORTHO TRI-CYCLEN, among other brands)
  • norgestrel and ethinyl estradiol (LO/OVRA, among other brands)
Phenothiazines (tranquilizers, anti-emetics)
  • chlorpromazine (available in generic only)*
  • fluphenazine (available in generic only)*
  • promethazine (PROMETHEGAN)*
  • thioridazine (available in generic only)**
Psoralens
  • methoxsalen (8-MOP, OXSORALEN, UVADEX)
Retinoids
  • acitretin (SORIATANE)
  • isotretinoin (ABSORICA, AMNESTEEM, CLARAVIS, among other brands)*
Sulfonamides
  • acetazolamide (DIAMOX)
  • sulfadiazine (available in generic only)
  • sulfasalazine (AZULFIDINE)
Sulfonylureas
  • glipizide (GLUCOTROL)*
  • glyburide (DIABETA, GLYNASE)*
Cosmetics containing alpha hydroxy acids
  • citric acid, glycolic acid, hydroxycapric acid, hydroxycaprylic acid, lactic acid (all sold under many brands)
*Limited Use
**Do Not Use

Rarely, the active ingredients in sunscreen may themselves cause photosensitivity.[8],[9] Yet these reactions are uncommon, and the benefits of sunscreen in terms of preventing skin cancer and sunburns far outweigh the rare risk of photosensitivity.[10]

What You Can Do

After learning that you are taking drugs that can cause photosensitivity, minimize your exposure to sunlight by seeking shade when you are outside, especially between 10 a.m. and 4 p.m. To limit sun exposure, wear protective clothing, such as long-sleeved shirts, pants, sunglasses and broad-brimmed hats. Always apply sunscreen on exposed skin when spending any time out in the sun.

If you have a reaction and are taking one of the prescription drugs described in this article, tell your doctor about the severity of your symptoms and discuss whether to try an alternative treatment or simply avoid sunlight exposure while taking the drug.

If you develop an unusual skin reaction after time in the sun, stop use of cosmetic products that contain alpha hydroxy acids and consider switching to a new sunscreen that uses different sun-blocking ingredients from any sunscreen products you have been using. Seek immediate medical attention in an emergency room if the skin reaction is severe.

Uncommonly, a chemical may cause photoallergy reactions that can continue even after the person is no longer being exposed to the chemical. If your skin problems persist, set up an appointment with a dermatologist to better diagnose your problem. If the dermatologist diagnoses a photoallergic reaction caused by one of your medicines, follow up with the prescribing doctor.

References

[1] Food and Drug Administration. The sun and your medicine. Last updated September 25, 2015. http://www.fda.gov/drugs/resourcesforyou/specialfeatures/ucm464195.htm. Accessed May 3, 2016.

[2] Ibid.

[3] Ibid.

[4] Ibid.

[5] Honari G. Photoallergy. Rev Environ Health. 2014;29(3):233-242.

[6] Food and Drug Administration. The sun and your medicine. Last updated September 25, 2015. http://www.fda.gov/drugs/resourcesforyou/specialfeatures/ucm464195.htm. Accessed May 3, 2016.

[7] Food and Drug Administration. Alpha hydroxyl acids. Last updated March 24, 2015. www.fda.gov/Cosmetics/ProductsIngredients/Ingredients/ucm107940.htm. Accessed May 3, 2016.

[8] Ibid.

[9] Honari G. Photoallergy. Rev Environ Health. 2014;29(3):233-242.

[10] Stechschulte SA, Kirsner RS, Federman DG. Sunscreens for non-dermatologists: What you should know when counseling patients. Postgrad Med. 2011;123(4):160-167.