DOCSLIB.ORG

Photosensitivity Due to Drugs

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Photosensitivity Due to Drugs General Information Drugs 30: 42-57 (1985) 00 12-6667/85/0700-0042/$08.00/0 © ADIS Press Limited All rights reserved. Photosensitivity Due to Drugs John H. Epstein and Bruce U. Wintroub Department of Dermatology, University of California, and Dermatology Service, Veterans Administration Medical Center, San Francisco Summllry Photosensitivity reactions induced by drugs may be phototoxic or photoallergic in na­ ture. Acute phototoxic reactions are by far the more common. and are generally charac­ terised by erythema and oedema followed by hyperpi gmentation and desquamation. Chronic repeated injury of this type may result in fragility. blistering and milia formation or even actinic keratoses and skin cancers. The photochemical mechanisms involved differ with the chemical photosensitiser involved. They include photoaddition of the chemical to bio­ logical targets such as DNA. the formation oftoxic products due to absorption ofthe action spectrum by the photosensitising molecule. or the activation oftoxic oxygen species or free radicals. Subsequent activation of the complement pathways may participate in the pho­ toresponse to certain agents. Photoallergic reactions are uncommon. They represent an acquired altered reactivity dependent on a circulating antibody or a cell-mediated hypersensitivity process. Clinically. they are characterised by an immediate wheal and flare or a delayed papular to ecze­ matous process. Some of the same drugs which cause phototoxic responses occasionally produce photoallergic reactions. Sun-induced cutaneous reactions have become or oxygen independent (non-photodynamic) [Blum, increasingly common over the past several dec­ 1941 a; Epstein, 1971]. Photoallergic reactions may ades, due not only to social causes centred on de­ be due to immediate antibody-mediated or delayed sires for a golden suntan, but also to the ever-ex­ cell-mediated (eMI) responses (Epstein, 1972; panding numbers and amounts of photosensitising Morison et aI., 1979). chemicals entering our environment - primarily Whichever type of response occurs, it must fol­ from cosmetic, pharmaceutical and industrial low the basic law of photochemical absorption sources. This article is concerned primarily with which states that non-ionising radiation must be the photosensitising effects of chemicals that are absorbed to produce a photochemical and subse­ used as medications therapeutically or as cosmet­ quently a photobiological reaction. This law then ics. stipulates that the photosensitising molecule must Two types of photosensitivity reactions may be be present at the time of the irradiation for the induced by such chemicals; i.e. they may be pho­ reaction to occur. In addition, the action spectrum totoxic or photoallergic in nature. Phototoxic re­ for any specific photoreaction must be included in actions may be oxygen dependent (photodynamic) the absorption spectrum of the photosensitiser. Photosensitivity Due to Drugs 43 1. Phototoxicity diation is the classic example of an acute photo­ toxic reaction. Phototoxic reactions may be drug-induced or Host effects may influence the natural history may accompany certain metabolic disorders in of drug-induced phototoxic reactions. Several fac­ which an appropriate photosensitising chemical is tors, including hair, pigment, and thickness of the available in target tissue. In each case, the photo­ stratum corneum, influence radiation penetration. toxic reaction occurs when enough chromophore Topical photosensitisers are dependent on percu­ (drug or metabolic product) absorbs sufficient ra­ taneous absorption and metabolism in the skin diation in reactive tissue. Drug-induced phototoxic (Anderson and Parrish, 1981). Systemic chrom­ reactions, whether from systemic administration ophores are influenced by gastrointestinal absorp­ or topical application, can occur in 100% of people tion, distribution and metabolism of the chemicals. on first exposure, and using appropriate experi­ In addition, increased humidity, temperature and mental conditions a dose-response curve can be wind also enhance phototoxic responses (Levine demonstrated with the incidence of phototoxicity and Harber, 1969; Owens and Knox, 1978). being related to the concentration of sensitisers and Histologically, epidermal cell degeneration may amount of light. This section focuses on the clinical be prominent when the photosensitiser or chrom­ expression and mechanism of phototoxicity due to ophore is in the epidermis (Epstein, 1971). This is topically or systemically administered drugs. It only most notable when a potent photosensitiser, such briefly considers phototoxicity which accompanies as a psoralen compound, is applied to the skin. In certain metabolic disorders, such as the porphy­ contrast, if the chromophore reaches the skin rias, in which a photo toxic metabolic product ac­ through the vasculature, the primary site of injury cumulates in skin as the result of an inborn meta­ may be in the dermis, with little or no visible epi­ bolic error. dermal change (Epstein, 1974). In both instances, there is generally little inflammatory cell response l.l Clinical Expressions in the dermis in human skin. When tissue is ex­ amined at a submicroscopic level, vascular injury 1.1.1 Acute Reactions is associated with protoporphyrin photosensitisa­ In general, acute phototoxic reactions are char­ tion (Honigsman et aI., 1976; Schnait et aI., 1975). acterised by erythema, oedema, and at times blister formation, followed by hyperpigmentation and de­ 1.1.2 Chronic Reactions squamation (Epstein, 1983). These reactions are Lifelong exposure to the sun (most notably UVB confined to sun-exposed skin. Immediate burning, rays) causes clinical cutaneous alterations which stinging sensations are characteristic of photosen­ include wrinkling, atrophy, hyper- and hypopig­ sitisation by certain chemicals such as coal tar, de­ men ted macules, telangiectasia, yellow papules and meclocycline (demethylchlortetracycline), and pro­ plaques, keratotic growths (actinic keratoses), and toporphyrin (in erythropoietic protoporphyria). The at times skin cancer formation. A distinctive, fur­ clinical reaction may begin from a few minutes to rowed, leathery appearance may be seen on the nu­ several hours after the irradiation and reach a peak chal area of fair-complexioned individuals. The from several hours to several days later. Acute ery­ chronically damaged skin is usually quite fragile, thema is usually associated with stimulation of' rupturing following mild trauma. In addition, the melanin formation, leading to subsequent hyper­ cutaneous blood vessels rupture easily, leading to pigmentation. areas of purpura; these are due to a loss of struc­ Since phototoxic injury results in cell death, tural support by the dermal connective tissue. sloughing of the dead epidermal cells presents as Histologically, effacement as well as projections desquamation or peeling. 'Sunburn' reaction in­ of the rete ridges, a possible thinning of the epi­ duced by ultraviolet B (UVB; 290 to 320nm) ra- dermis, and the presence of many abnormal ker- Photosensitivity Due to Drugs 44 atinocytes in disorderly arrangement may be seen. 1.2 Mechanisms In the dermis, there is a progressive degeneration in the papillary and subpapillary zones. Specific The interactions of light, phototoxic chemicals changes include the development of vascular ec­ and their biological targets may result from several tasia, the accumulation of acid mucopolysacchar­ types of photochemical reactions. In each case,' ides and abnormal-appearing fibrocytes, the loss of damage to biological substrates is initiated by the collagen (but an increase in the soluble compo­ absorption of light energy by a phototoxic com­ nent), and the marked increase and degeneration pound. As already noted, phototoxic reactions have of elastic tissue, referred to as actinic elastosis. Al­ been divided into 2 categories: oxygen-dependent though there is still some question as to the origin (photodynamic) and oxygen-independent (non­ of the fibres which stain like elastic tissue, bio­ photodynamic) [Blum, 1941a; Epstein, 1971]. In chemical and electron microscopic studies have the case of drug-induced phototoxicity, recent confirmed that actinic elastosis is due to the ac­ studies have resulted in a more detailed under­ cumulation of elastic tissue. standing of the various mechanisms of phototox­ In general, most drug-induced phototoxic re­ icity. actions are acute and phototoxicity may necessi­ At least 3 distinct photochemical mechanisms tate discontinuation of the drug. However, chronic have been described in in vitro systems (Kochevar, actinic changes have been associated with a form 1981). Firstly, the direct reaction between the ex­ of dermatological psoriasis therapy in which pho­ cited state of a phototoxic molecule and a biologi­ tochemotherapy is employed. In a large series of cal target may result in the formation of a covalent psoriatic patients treated with psoralens and ultra­ photoaddition product which is comprised of the violet A (UV A; 320 to 400nm) radiation (PUV A), compound itself and the biological target. Exam­ a definite increase in cutaneous cancer formation ples include photoaddition of chlorpromazine to was noted (Stern et aI., 1979). In addition, there is protein or DNA, or the light-induced formation of histological evidence of focal dystrophy of epi­ a photoadduct of methoxsalen (8-methoxypsora­ dermal cells, atypical changes in melanocytes, len; 8-MOP) and a pyrimidine base in the DNA and deposition
Load more

Recommended publications
  • Antimicrobial Photosensitive Reactions
    REVIEW ARTICLE Antimicrobial Photosensitive Reactions Snejina G. Vassileva, MD; Grisha Mateev, MD; Lawrence Charles Parish, MD hotosensitivity reactions are recognized as unwanted adverse effects of an array of com- monly administered topical or systemic medications, including nonsteroidal anti- inflammatory agents, antifungals, and antimicrobials. When a drug induces photosen- sitivity, exogenous molecules in the skin absorb normally harmless doses of visible and PUV light, leading to an acute inflammatory response. In phototoxic reactions, the damage to tissues is direct; in photoallergic reactions, it is immunologically mediated. In vitro and in vivo assay sys- tems can assist in predicting or confirming drug photosensitivity. The incidence of photosensitivity reactions may be too low to be detected in clinical studies and may become recognized only in the postmarketing stage of drug development. Some drugs have been withdrawn because of photosen- sitivity effects that appeared after general release. Photosensitivity reactions have been studied for a number of topical antimicrobials and for the sulfonamides, griseofulvin, the tetracyclines, and the quinolones. Incidence and intensity of drug phototoxicity can vary widely among the different com- pounds of a given class of antimicrobials. When phototoxic effects are relatively low in incidence, mild, reversible, and clinically manageable, the benefits of an antimicrobial drug may well outweigh the potential for adverse photosensitivity effects. Arch Intern Med. 1998;158:1993-2000 Photosensitivity caused by drug reac- bined with exposure to sunlight to treat tions may be defined as unwanted phar- vitiligo.1 These herbal remedies were redis- macological effects produced when the covered in the 1940s and identified as con- skin is sensitized by topical or systemic taining the phototoxic furocoumarins medications, or both, and exposed to UV (psoralens).
    [Show full text]
  • Drug-Induced Photosensitivity
    Acta Dermatovenerol Croat 2016;24(1):55-64 REVIEW Drug-induced Photosensitivity Ewelina Bogumiła Zuba1, Sandra Koronowska1, Agnieszka Osmola- Mańkowska2, Dorota Jenerowicz2 1Student Scientific Group at the Department of Dermatology, Medical University of Poznan, Poznan, Poland; 2Department of Dermatology, Medical University of Poznan, Poznan, Poland Corresponding author: ABSTRACT Ultraviolet radiation is considered the main environmental Ewelina Bogumiła Zuba MD physical hazard to the skin. It is responsible for photoaging, sunburns, carcinogenesis, and photodermatoses, including drug-induced photo- Medical University of Poznan sensitivity. Drug-induced photosensitivity is an abnormal skin reaction 49 Przybyszewskiego St either to sunlight or to artificial light. Drugs may be a cause of photoal- 60-355 Poznan lergic, phototoxic, and photoaggravated dermatitis. There are numerous medications that can be implicated in these types of reactions. Recently, Poland non-steroidal anti-inflammatory drugs have been shown to be a com- [email protected] mon cause of photosensitivity. As both systemic and topical medica- tions may promote photosensitive reactions, it is important to take into Received: November 17, 2014 consideration the potential risk of occurrence such reactions, especially Accepted: January 10, 2016 in people chronically exposed to ultraviolet radiation. KEY WORDS: photoallergic contact dermatitis, photosensitizing agents, phototoxic dermatitis INTRODUCTION Drug-induced photosensitivity is an undesirable Photosensitivity might be associated with differ- effect of topically applied or systemically adminis- ent mechanisms such as phototoxicity, photoallergy, trated pharmaceuticals, followed by exposition to pellagra, pseudoporphyria, lichenoid, and lupus ery- sunlight, mainly ultraviolet A (UVA) or/and ultraviolet thematosus reactions. The most common are pho- B (UVB) radiation as well as visible light.
    [Show full text]
  • Scientific Problems of Photosensitivity
    Medicina (Kaunas) 2006; 42(8) 619 Scientific problems of photosensitivity Rūta Dubakienė, Miglė Kuprienė Republican Center of Allergology, Vilnius University, Lithuania Keywords: photosensitivity, photosensitizers, phototoxic reaction, photoallergic reaction. Summary. 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. History of the problem photoreactive agents could be found in products and Photosensitive reactions have been recognized for how to prevent or control photosensitivity disorders. thousands of years. In ancient Egypt, India, and Greece psoralen-containing plants extracts were combined Photosensitivity reactions with exposure to sunlight to treat skin diseases. Photosensitivity is an adverse cutaneous
    [Show full text]
  • Drug-Induced Photosensitivity—From Light and Chemistryto Biological
    pharmaceuticals Review Drug-Induced Photosensitivity—From Light and Chemistry to Biological Reactions and Clinical Symptoms Justyna Kowalska, Jakub Rok , Zuzanna Rzepka and Dorota Wrze´sniok* Department of Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia in Katowice, Jagiello´nska4, 41-200 Sosnowiec, Poland; [email protected] (J.K.); [email protected] (J.R.); [email protected] (Z.R.) * Correspondence: [email protected]; Tel.: +48-32-364-1611 Abstract: Photosensitivity is one of the most common cutaneous adverse drug reactions. There are two types of drug-induced photosensitivity: photoallergy and phototoxicity. Currently, the number of photosensitization cases is constantly increasing due to excessive exposure to sunlight, the aesthetic value of a tan, and the increasing number of photosensitizing substances in food, dietary supplements, and pharmaceutical and cosmetic products. The risk of photosensitivity reactions relates to several hundred externally and systemically administered drugs, including nonsteroidal anti-inflammatory, cardiovascular, psychotropic, antimicrobial, antihyperlipidemic, and antineoplastic drugs. Photosensitivity reactions often lead to hospitalization, additional treatment, medical management, decrease in patient’s comfort, and the limitations of drug usage. Mechanisms of drug-induced photosensitivity are complex and are observed at a cellular, molecular, and biochemical level. Photoexcitation and photoconversion of drugs trigger multidirectional biological reactions, including oxidative stress, inflammation, and changes in melanin synthesis. These effects contribute Citation: Kowalska, J.; Rok, J.; to the appearance of the following symptoms: erythema, swelling, blisters, exudation, peeling, Rzepka, Z.; Wrze´sniok,D. burning, itching, and hyperpigmentation of the skin. This article reviews in detail the chemical and Drug-Induced biological basis of drug-induced photosensitivity.
    [Show full text]
  • Light Sensitivity
    Scientific Committee on Emerging and Newly Identified Health Risks SCENIHR Light Sensitivity The SCENIHR adopted this opinion at the 26th Plenary on 23 September 2008. Light Sensitivity About the Scientific Committees Three independent non-food Scientific Committees provide the Commission with the scientific advice it needs when preparing policy and proposals relating to consumer safety, public health and the environment. The Committees also draw the Commission's attention to the new or emerging problems which may pose an actual or potential threat. They are: the Scientific Committee on Consumer Products (SCCP), the Scientific Committee on Health and Environmental Risks (SCHER) and the Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR) and are made up of external experts. In addition, the Commission relies upon the work of the European Food Safety Authority (EFSA), the European Medicines Evaluation Agency (EMEA), the European Centre for Disease prevention and Control (ECDC) and the European Chemicals Agency (ECHA). SCENIHR The work of SCENIHR involves questions concerning emerging or newly-identified risks and on broad, complex or multi-disciplinary issues requiring a comprehensive assessment of risks to consumer safety or public health and related issues not covered by other Community risk-assessment bodies. In particular, the Committee addresses questions related to potential risks associated with interaction of risk factors, synergic effects, cumulative effects, antimicrobial resistance, new technologies such as nanotechnologies, medical devices, tissue engineering, blood products, fertility reduction, cancer of endocrine organs, physical hazards such as noise and electromagnetic fields and methodologies for assessing new risks. Scientific Committee members Anders Ahlbom, James Bridges, Wim De Jong, Philippe Hartemann, Thomas Jung, Mats- Olof Mattsson, Jean-Marie Pagès, Konrad Rydzynski, Dorothea Stahl, Mogens Thomsen.
    [Show full text]
  • Latest Evidence Regarding the Effects of Photosensitive Drugs on the Skin
    pharmaceutics Review Latest Evidence Regarding the Effects of Photosensitive Drugs on the Skin: Pathogenetic Mechanisms and Clinical Manifestations Flavia Lozzi 1, Cosimo Di Raimondo 1 , Caterina Lanna 1, Laura Diluvio 1, Sara Mazzilli 1, Virginia Garofalo 1, Emi Dika 2, Elena Dellambra 3 , Filadelfo Coniglione 4, Luca Bianchi 1,* and Elena Campione 1,* 1 Dermatology Unit, Department of Internal Medicine, Tor Vergata University, 00133 Rome, Italy; fl[email protected] (F.L.); [email protected] (C.D.R.); [email protected] (C.L.); [email protected] (L.D.); [email protected] (S.M.); [email protected] (V.G.) 2 Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Via Massarenti, 1-40138 Bologna, Italy; [email protected] 3 Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell’Immacolata–Istituto di Ricovero e Cura a Carattere Scientifico (IDI-IRCCS), via dei Monti di Creta 104, 00167 Rome, Italy; [email protected] 4 Department of Clinical Science and Translational Medicine, Tor Vergata University, 00133 Rome, Italy; fi[email protected] * Correspondence: [email protected] (L.B.); [email protected] (E.C.); Tel.: +39-0620908446 (E.C.) Received: 5 October 2020; Accepted: 2 November 2020; Published: 17 November 2020 Abstract: Photosensitivity induced by drugs is a widely experienced problem, concerning both molecule design and clinical practice. Indeed, photo-induced cutaneous eruptions represent one of the most common drug adverse events and are frequently an important issue to consider in the therapeutic management of patients. Phototoxicity and photoallergy are the two different pathogenic mechanisms involved in photosensitization.
    [Show full text]
  • Phytophotodermatitis: Case Report and Review of the Literature Paul H
    REVIEW Phytophotodermatitis: Case Report and Review of the Literature Paul H. Janda, DO; Sanjay Bhambri, DO; James Q. Del Rosso, DO; Narciss Mobini, MD Phytophotodermatitis is a common phototoxic dermal reaction caused by the interaction between certain plants, sunlight, and human skin. The causal agents in plants have been identified as furocouma- rins, which are photoactive compounds. Although the plants causing phytophotodermatitis vary, in the United States phytophotodermatitis most commonly occurs following exposure to plants belonging to the Rutaceae and Umbelliferae families. COS DERM 3 hytophotodermatitis is a common phototoxic and then followed by hyperpigmentation. Phytophoto- dermal reaction caused by the interaction dermatitis is associated with minimal symptomatology between certain plants, sunlight, and human and morbidity, although persistent hyperpigmentation skin. Klaber1 was the first to coin the term in may be bothersome or worrisome to some patients, espe- 1942. The causalDo agents in plantsNot have been cially Copy when it occurs at commonly exposed locations (ie, identifiedP as furocoumarins, which are photoactive com- face and hands).4 Accurately recognizing the symptoms of pounds.2 Although the plants causing phytophotoderma- phytophotodermatitis is important in avoiding misdiag- titis vary, in the United States phytophotodermatitis most nosis and preventing repeated episodes of exposure; phy- commonly occurs following exposure to plants belonging tophotodermatitis has been misdiagnosed as a cutaneous to the Rutaceae and Umbelliferae families.3 Phytopho- sign of child abuse.6-8 todermatitis is a phototoxic reaction, occurring in skin exposed to UV radiation after contact with plants con- CASE REPORT taining furocoumarins.4,5 The clinical changes most com- A 9-year-old white female, accompanied by her mother, monly include erythema, followed by vesiculation with presented with a 4-week history of perioral hyperpig- development of bullae in the skin 24 to 72 hours later mentation.
    [Show full text]
  • Drug-Induced Photosensitivity—An Update Forearms and Hands
    Drug Safety https://doi.org/10.1007/s40264-019-00806-5 REVIEW ARTICLE Drug‑Induced Photosensitivity—An Update: Culprit Drugs, Prevention and Management Kim M. Blakely1 · Aaron M. Drucker1,2 · Cheryl F. Rosen1,3 © Springer Nature Switzerland AG 2019 Abstract Photosensitive drug eruptions are cutaneous adverse events due to exposure to a medication and either ultraviolet or visible radiation. In this review, the diagnosis, prevention and management of drug-induced photosensitivity is discussed. Diagnosis is based largely on the history of drug intake and the appearance of the eruption primarily afecting sun-exposed areas of the skin. This diagnosis can also be aided by tools such as phototesting, photopatch testing and rechallenge testing. The mainstay of management is prevention, including informing patients of the possibility of increased photosensitivity as well as the use of appropriate sun protective measures. Once a photosensitivity reaction has occurred, it may be necessary to discontinue the culprit medication and treat the reaction with corticosteroids. For certain medications, long-term surveillance may be indicated because of a higher risk of developing melanoma or squamous cell carcinoma at sites of earlier photosensitivity reactions. A large number of medications have been implicated as causes of photosensitivity, many with convincing clinical and scientifc supporting evidence. We review the medical literature regarding the evidence for the culpability of each drug, including the results of phototesting, photopatch testing and rechallenge testing. Amiodarone, chlorpromazine, doxycycline, hydrochlorothiazide, nalidixic acid, naproxen, piroxicam, tetracycline, thioridazine, vemurafenib and voriconazole are among the most consistently implicated and warrant the most precaution by both the physician and patient.
    [Show full text]
  • Photosensitivity: System
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by OAR@UM – photoperiodicity; is used by animals to synchronize their biological clocks. Light is indeed important for the psychological well being of animals. However the effect of light on humans is much more complex than we think. It influences us in ways we many times do not expect or understand. At least one study has suggested a direct correlation between higher rates of breast cancer in women and the night time brightness of their neighbourhoods.1 It is in fact postulated that this is at least partly due to a dramatic alteration in the lighted environment from a sun-based system to an electricity-based Photosensitivity: system. Increasingly, the natural dark period at night is being seriously eroded for the bulk of humanity.2 Based on the fact Light, sun and pharmacy that light during the night can suppress melatonin, and also disrupt the circadian rhythm, it is proposed that increasing use of Mark L. Zammit BPharm(Hons), MSc(Agr Vet Pharm), Pg Dip Med Tox(Cardiff), MSc Med Tox(Cardiff), MEAPCCT electricity to light the night accounts in part for the rising risk of breast cancer globally.3 Principal Pharmacist, Clinical Pharmacy and Medicines & Poisons Information, Light is nowadays being even considered as a Pharmacy Department, Mater Dei Hospital, Malta public health issue.4 Email: [email protected] Photosensitivity and its epidemiology In the context of pharmacy, an Educational aims important effect of light is what is • To provide an overview of different types of drug-induced photosensitivity reactions termed as photosensitivity.
    [Show full text]
  • Photosensitivity : an Increasing Problem
    University of Nebraska Medical Center DigitalCommons@UNMC MD Theses Special Collections 5-1-1969 Photosensitivity : an increasing problem Terry R. Rusthoven University of Nebraska Medical Center This manuscript is historical in nature and may not reflect current medical research and practice. Search PubMed for current research. Follow this and additional works at: https://digitalcommons.unmc.edu/mdtheses Part of the Medical Education Commons Recommended Citation Rusthoven, Terry R., "Photosensitivity : an increasing problem" (1969). MD Theses. 122. https://digitalcommons.unmc.edu/mdtheses/122 This Thesis is brought to you for free and open access by the Special Collections at DigitalCommons@UNMC. It has been accepted for inclusion in MD Theses by an authorized administrator of DigitalCommons@UNMC. For more information, please contact [email protected]. PHOTOSENSITIVITY, AN INCREASING PROBLEM By Terry R. Rusthoven A THESIS Presented to the Faculty of The College of Medicine in the University of Nebraska In Partial Fulfillment of Requirements For the Degree of Doctor of Medicine Under the Supervision of Dr. C. Wilhelmj Chairman of Department of Dermatology Omaha, Nebraska February 1, 1969 Outline I. Introduction 1. Natural sunlight 2. Suntan 3. Sunburn 4. Skin defenses against sunlight 5. Diseases affected by ultraviolet rays II. Descriptive Terms 1. Photoallergy vs. phototoxicity III. Types of Photosensitivity 1. Drug sensitivity 2. Plant sensitivity 3. Soap ,sensitivity 4. Polymorphous light eruption 5. Persistent light reactors IV. Patch Testing 1. Minimal erythema dose 2. Delayed erythema dose 3. Office testing 4. Scotch Tape Provocative Patch Test V. Drug Photosensitivity 1. Drugs involved 2. Mechanisms of reaction 3. Reactions with sulfa drugs 4.
    [Show full text]