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Photoreactions and Testing

  • Margarida Gonçalo

Abstract

Skin reactions induced by exposure to UV light and photoactive chemicals can be phototoxic or photoallergic or can involve both mechanisms. Phototoxic reactions present as exaggerated sunburn, eventually with bullae and hyperpigmentation, whereas an eczematous pattern in photoexposed areas is mainly observed in photoallergy.

Photopatch testing (duplicate patch testing with irradiation of one set with 5 J/cm2 UVA) is the recommended diagnostic test in photoallergic contact dermatitis (PhACD), but it may be useful to photopatch test all patients with dermatitis in sun-exposed areas, with a history of aggravation by the sun or with exposure to UV filters or NSAIDs, the main causes of PhACD. A baseline and extended series of photoactive chemicals has been recommended to be tested in patients along with their own products.

Further avoidance of chemicals and cross-reactive substances that cause photoallergy is necessary for resolution of the dermatitis. For phototoxic chemicals when avoidance is not possible (systemic drugs), other photoprotection measures are mandatory, as there is increasing evidence of relation between nonmelanoma skin cancer and exposure to these chemicals.

Keywords

Photosensitivity Phototoxicity Photoallergy UV filters Drug photosensitivity Photopatch test 

References

  1. 1.
    Ferguson J. Drug and chemical photosensitivity. 1st ed. New York: Oxford University Press; 1999. p. 155–69.Google Scholar
  2. 2.
    Gonçalo M. Phototoxic and photoallergic reactions. In: Johansen J, Frosch P, Lepoittevin J, editors. Contact dermatitis. 5th ed. Berlin: Springer; 2011. p. 361–76.CrossRefGoogle Scholar
  3. 3.
    Canelas MM, Cardoso JC, Gonçalo M, Figueiredo A. Photoallergic contact dermatitis from benzydamine presenting mainly as lip dermatitis. Contact Dermatitis. 2010;63(2):85–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Conti R, Bassi A, Difonzo EM, Moretti S, Francalanci S. A case of photoallergic contact dermatitis caused by unusual exposure to ketoprofen. Dermatitis. 2012;23(6):295–6.CrossRefPubMedGoogle Scholar
  5. 5.
    Lovell C. Phytophotodermatitis. Boca Raton: CRC Press; 2000. p. 51–65.Google Scholar
  6. 6.
    Dummer R, Rinderknecht J, Goldinger S. Ultraviolet A and photosensitivity during vemurafenib therapy. N Engl J Med. 2012;366(5):480–1.CrossRefPubMedGoogle Scholar
  7. 7.
    Gelot P, Dutartre H, Khammari A, Boisrobert A, Schmitt C, Deybach J, et al. Vemurafenib: an unusual UVA-induced photosensitivity. Exp Dermatol. 2013;22(4):297–8.CrossRefPubMedGoogle Scholar
  8. 8.
    McCarthy K, Playforf E, Looke D, Whitby M. Severe photosensitivity causing multifocal squamous cell carcinomas secondary to prolonged voriconazole therapy. Clin Inf Dis. 2007;44:e55–6.CrossRefGoogle Scholar
  9. 9.
    Cowen E, Nguyen J, Miller D, Mcshane D, Arron S, Prose N, et al. Chronic phototoxicity and aggressive squamous cell carcinoma of the skin in children and adults during treatment with voriconazole. J Am Acad Dermatol. 2010;62:31–7.PubMedCentralCrossRefPubMedGoogle Scholar
  10. 10.
    Miller D, Cowen E, Nguyen J, McCalmont T, Fox L. Melanoma associated with long-term voriconazole therapy: a new manifestation of chronic photosensitivity. Arch Dermatol. 2010;146(3):300–4.CrossRefPubMedGoogle Scholar
  11. 11.
    Rinderknecht JD, Goldinger SM, Rozati S, Kamarashev J, Kerl K, French LE, et al. RASopathic skin eruptions during Vemurafenib therapy. PLoS One. 2013;8(3):e58721.PubMedCentralCrossRefPubMedGoogle Scholar
  12. 12.
    La Cuadra-Oyanguren J, Pérez-Ferriols A, Lecha-Carralero M, Giménez-Arnau A, Fernández-Redondo V, Ortiz de Frutos F, et al. Results and assessment of photopatch testing in Spain: towards a new standard set of photoallergens. Actas Dermosifiliogr. 2007;98:96–101.CrossRefPubMedGoogle Scholar
  13. 13.
    Cardoso JC, Canelas MM, Gonçalo M, Figueiredo A. Photopatch testing with an extended series of photoallergens: a 5-year study. Contact Dermatitis. 2009;60(6):325–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Bryden A, Moseley H, Ibbotson S, Chowdhury M, Beck M, Bourke J, et al. Photopatch testing of 1115 patients: results of the U.K. multicentre photopatch study group. Br J Dermatol. 2006;155:737–47.CrossRefPubMedGoogle Scholar
  15. 15.
    Pigatto P, Guzzi G, Schena D, Guarrera M, Foti C, Francalanci S, et al. Photopatch tests: an Italian multicentre study from 2004 to 2006. Contact Dermatitis. 2008;59(2):103–8.CrossRefPubMedGoogle Scholar
  16. 16.
    EMCPPTS Taskforce, Kerr A, Ferguson J, Haylett A, Rhodes L, Adamski H, et al. A European multicentre photopatch test study. Br J Dermatol. 2012;166(5):1002–9.CrossRefGoogle Scholar
  17. 17.
    Uter W, Gonçalo M, Yazar K, Kratz E-M, Mildau G, Lidén C. Coupled exposure to ingredients of cosmetic products: III. Ultraviolet filters. Contact Dermatitis. 2014;71(3):162–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Haylett A, Chiang Y, Nie Z, Ling T, Rhodes L. Sunscreen photopatch testing: a series of 157 children. Br J Dermatol. 2014;171(2):370–5.CrossRefPubMedGoogle Scholar
  19. 19.
    Andersen K, Goossens A. Decyl glucoside contact allergy from a sunscreen product. Contact Dermatitis. 2006;54:349–50.CrossRefPubMedGoogle Scholar
  20. 20.
    Andrade P, Gonçalo M, Figueiredo A. Allergic contact dermatitis to decyl glucoside in Tinosorb M. Contact Dermatitis. 2010;62(2):119–20.CrossRefPubMedGoogle Scholar
  21. 21.
    Guy R, Kuma H, Nakanishi M. Serious photocontact dermatitis induced by topical ketoprofen depends on the formulation. Eur J Dermatol. 2014;24(3):365–71.PubMedGoogle Scholar
  22. 22.
    Sugiura M, Hayakawa R, Kato Y, Sugiura K, Ueda H. 4 cases of photocontact dermatitis due to ketoprofen. Contact Dermatitis. 2000;43:16–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Hindsén M, Isaksson M, Persson L, Zimersson E, Bruze M. Photoallergic contact dermatitis from ketoprofen induced by drug-contaminated personal objects. J Am Acad Dermatol. 2004;50:215–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Veyrac G, Paulin M, Milpied B, Bourin M, Jolliet P. Bilan de l’enquête nationale sur les effets indésirables cutanés do kétoprofène gel enregistrés entre le 01/09/1996 et le 31/08/2000. Therapie. 2002;57(1):55–64.PubMedGoogle Scholar
  25. 25.
    Devleeschouwer V, Roelandts R, Garmyn M, Goossens A. Allergic and photoallergic contact dermatitis from ketoprofen: results of (photo) patch testing and follow-up of 42 patients. Contact Dermatitis. 2008;58:159–66.CrossRefPubMedGoogle Scholar
  26. 26.
    Izu K, Hino R, Isoda H, Nakashima D, Kabashima K, Tokura Y. Photocontact dermatitis to ketoprofen presenting with erythema multiforme. Eur J Dermatol. 2008;18:710–3.PubMedGoogle Scholar
  27. 27.
    Béani J. Les photosensibilisations graves. Ann Dermatol Venereol. 2009;136:76–83.CrossRefPubMedGoogle Scholar
  28. 28.
    LeCoz C, Bottlaender A, Scrivener J-N, Santinelli F, Cribier B, Heidei E, et al. Photocontact dermatitis from ketoprofen and tiaprofenic acid: cross-reactivity study in 12 consecutive patients. Contact Dermatitis. 1998;38:245–52.CrossRefGoogle Scholar
  29. 29.
    Pigatto P, Bigardi A, Legori A, Valsecchi R, Picardo M. Cross reactions in patch testing and photopatch testing with ketoprofen, tiaprofenic acid and cinnamic aldehyde. Am J Contact Dermat. 1996;7:220–3.PubMedGoogle Scholar
  30. 30.
    Girardin P, Vigan M, Humbert P, Aubin F. Cross reactions in patch testing with ketoprofem, fragrance mix and cinnamic derivatives. Contact Dermatitis. 2006;55(2):126–8.CrossRefPubMedGoogle Scholar
  31. 31.
    Avenel-Audrun M, Dulartre H, Goossens A, Jeanmougin M, Comte C, Bernier C, et al. Octocrylene, an emerging photoallergen. Arch Dermatol. 2010;146(7):753–7.Google Scholar
  32. 32.
    Karlsson I, Vanden Broecke K, Martensson J, Goossens A, Borje A. Clinical and experimental studies of octocrylene’s allergenic potency. Contact Dermatitis. 2011;64(6):343–52.CrossRefPubMedGoogle Scholar
  33. 33.
    Infante Hernando L, Serra-Baldrich E, Dordal T, Puig SL. Photoallergic contact dermatitis caused by benzophenones in magazine inks. Contact Dermatitis. 2013;69(2):124–6.CrossRefPubMedGoogle Scholar
  34. 34.
    Gonçalo M, Figueiredo A, Tavares P, Fontes Ribeiro C, Teixeira F, Poiares BA. Photosensitivity to piroxicam: absence of cross reaction with tenoxicam. Contact Dermatitis. 1992;27:287–90.CrossRefPubMedGoogle Scholar
  35. 35.
    Lasa Elgezua O, Gorrotxategi P, Gardeazabal Gracia J, Ratón Nieto J, Pérez J. Photoallergic hand eczema due to benzydamine. Eur J Dermatol. 2004;14(1):69–70.PubMedGoogle Scholar
  36. 36.
    Barbaud A, Collet E, Martin S, Granel F, Tréchot P, Lambert D, et al. Contact sensitization to chlorproéthazine can induce persistent light reaction and cross photoreactions to other phenothiazines. Contact Dermatitis. 2001;44:373.PubMedGoogle Scholar
  37. 37.
    Kerr A, Woods J, Ferguson J. Photocontact allergic and phototoxic studies of chlorproethazine. Photodermatol Photoimmunol Photomed. 2008;24:11–5.CrossRefPubMedGoogle Scholar
  38. 38.
    Bibas N, Sartor V, Bulai Livideanu C, Bagheri H, Nougué J, Giordano-Labadie F, et al. Contact photoallergy to isothipendyl chlorhydrate. Dermatology. 2012;224(4):289–91.CrossRefPubMedGoogle Scholar
  39. 39.
    Monteagudo-Paz A, Salvador JS, Martinez NL, Granados PA, Martínez PS. Pulpitis as clinical presentation of photoallergic contact dermatitis due to chlorpromazine. Allergy. 2011;66(11):1503–4.CrossRefPubMedGoogle Scholar
  40. 40.
    Gonçalo M. Explorations dans les photo-allergies médicamenteuses. In: GERDA, editor. Progrès en Dermato-allergologie. Nancy: John Libbey Eurotext; 1998. p. 67–74.Google Scholar
  41. 41.
    Bruynzeel D, Ferguson J, Andersen K, Gonçalo M, English J, Goossens A, et al. Photopatch testing: a consensus methodology for Europe. JEADV. 2004;18:679–82.PubMedGoogle Scholar
  42. 42.
    Gonçalo M, Ferguson J, Bonevalle A, Bruynzeel DP, Giménez-Arnau A, Goossens A, et al. Photopatch testing: recommendations for a European photopatch test baseline series. Contact Dermatitis. 2013;68(4):239–43.CrossRefPubMedGoogle Scholar
  43. 43.
    Batchelor R, Wilkinson S. Photopatch testing – a retrospective review using the 1 day and 2 day irradiation protocols. Contact Dermatitis. 2006;54:75–8.CrossRefPubMedGoogle Scholar
  44. 44.
    Avenel-Audrun M. Photopatch testing. Ann Dermatol Venereol. 2009;136:626–9.CrossRefGoogle Scholar
  45. 45.
    Goossens A. Photoallergic contact dermatitis. Photodermatol Photoimmunol Photomed. 2004;20:121–5.CrossRefPubMedGoogle Scholar
  46. 46.
    Beattie P, Traynor N, Woods J, Dawe R, Ferguson J, Ibbotson S. Can a positive photopatch test be elicited by subclinical irritancy or allergy plus suberythemal UV exposure? Contact Dermatitis. 2004;51:235–40.CrossRefPubMedGoogle Scholar
  47. 47.
    Gonçalo M, Ruas E, Figueiredo A, Gonçalo S. Contact and photocontact sensitivity to sunscreens. Contact Dermatitis. 1995;33(4):278–80.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Clinic of DermatologyUniversity Hospital and Faculty of Medicine, University of CoimbraCoimbraPortugal

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