Drug-Induced Phototoxicity: A Systematic Review

Publication date: Available online 10 July 2018

Source: Journal of the American Academy of Dermatology

Author(s): Whan B. Kim, A.J. Shelley, K. Novice, J. Joo, H.W. Lim, S.J. Glassman

Abstract

Background

Phototoxicity has been attributed to numerous oral drugs over the past 60 years.

Objective

Determine the quality of evidence supporting suspected phototoxicity from oral drugs

Methods

MEDLINE and EMBASE databases were searched for all studies containing original data for drug-induced phototoxicity published between May 1959 and December 2016. Study quality was assessed using a modified GRADE scale.

Results

The review included 240 eligible studies with a total of 2466 subjects. There were 1134 cases of suspected phototoxicity associated with 129 drugs. Most associations were supported by either very low-quality or low-quality evidence (89.1% of the studies). Medications supported by stronger evidence were vemurafenib, non-steroidal anti-inflammatory drugs (NSAIDs), and antibiotics, specifically fluoroquinolones and tetracyclines. The most frequently reported drugs were: vemurafenib, voriconazole, doxycycline, hydrochlorothiazide, amiodarone, and chlorpromazine. Photobiologic evaluation was performed in only 56 studies (23.3%), while challenge-rechallenge was done in 10% of cases.

Limitations

Only English-language publications were reviewed. Phototoxicity cases incorrectly termed photoallergy would not have been included.

Conclusions

Most purported associations between oral drugs and phototoxicity are not supported by high-quality evidence. Despite the variable quality of data, clinicians should be aware of the possible consequences of chronic use of culprit drugs.