Medications and cutaneous reactions to sunlight: analysis of photosensitizing agents

Abstract

 Adverse cutaneous reactions to sun exposure are an important aspect of medication side effects. Approximately 10% of the population may experience such reactions, with hospitalized patients being at increased risk. These reactions can be categorized into phototoxic and photoallergic reactions, each with different mechanisms of action. This research aims to analyze the range of medications with photosensitizing potential and the mechanisms involved in adverse cutaneous reactions to sun exposure. Materials and Methods An analysis of the specialized literature from databases such as PubMed Central, Scopus, Cochrane Library, Medline, HINARI, Google Scholar, and Web of Science over the past 20 years was conducted to identify medications with photosensitizing potential and their mechanisms of action. The analysis included the main classes of medications reported to be associated with adverse cutaneous reactions to sun exposure. Results The analysis identified numerous classes of medications with photosensitizing potential. The relative proportion of potential photosensitizers by major medication class includes: antipsychotic medications (chlorpromazine, trifluoperazine, perphenazine), antibiotics (very high risk for tetracyclines, macrolides), nonsteroidal anti-inflammatory drugs (high risk for ibuprofen, naproxen, diclofenac), fluoroquinolones (ciprofloxacin and ofloxacin), sulfonamides (sulfamethoxazole), hormonal contraceptives (containing certain types of progesterone such as gestodene and desogestrel), retinoids (tretinoin (retinoic acid), isotretinoin, and adapalene), diuretics (thiazides), and others. Adverse cutaneous reactions can be classified into phototoxic and photoallergic reactions, each with specific mechanisms of action. Phototoxic reactions are dose-dependent and can occur at the first sun exposure, while photoallergic reactions are immune-mediated and occur in sensitized individuals. Discussions The mechanisms of photosensitization involve the absorption of solar radiation by medications, generating free radicals and adverse cutaneous reactions. Some medications present a higher risk of phototoxicity or photoallergy, and factors such as the drug dose, treatment duration, and sun exposure influence the severity of adverse cutaneous reactions. Conclusions It is essential for physicians to be aware of the risk of photosensitization associated with certain classes of medications and to provide patients with appropriate information and preventive measures. Patient education, sun protection, and careful monitoring of cutaneous reactions are important for the effective management of these adverse effects and for improving patients’ quality of life.