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Voriconazole-induced photosensitivity: photobiological assessment of a case series of 12 patients.
MedLine Citation:
PMID:  22860570     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background  Voriconazole, a broad-spectrum triazole antifungal agent increasingly used to treat aspergillosis, has been linked with acute photosensitivity and skin carcinogenesis. The action spectrum of the photosensitivity is unknown, whilst an indirect retinol effect secondary to the anti-fungal's impact on CYP450 enzymes has been proposed to contribute to the underlying mechanism. Objectives  To perform a detailed photobiological assessment of the photosensitivity presenting in a series of 12 voriconazole treated patients. Results  Patients (8 male, 4 female; median age 54y, range 40-63y) experienced moderate-severe cutaneous erythema (n=12), burning pain (n=5), itching (n=3), scaling (n=5), vesiculation (n=5) and oedema (n=1) following sunlight exposure; increased lentigines (n=5) and actinic cheilitis (n=3) were also observed. While the majority (n=8) of patients showed normal minimal erythemal (MED) thresholds to monochromator phototesting to UVB, UVA and visible light, a low MED to UVA was observed in 4 patients. Repeated provocation testing with broadband UVA and solar simulated radiation (SSR) provoked an abnormal erythema in 8 and 10 patients, respectively. Serum retinol levels were mildly elevated in 2 patients but normal in the majority Conclusion  UVA sensitivity is the predominant finding in acute voriconazole induced photosensitivity. We found little evidence of elevated circulating retinol as the causal factor. Patients with voriconazole-induced photosensitivity require education in appropriate UVA protective measures in addition to consideration of skin surveillance for malignant sequelae.
Authors:
A K Haylett; S Felton; D W Denning; L E Rhodes
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-3
Journal Detail:
Title:  The British journal of dermatology     Volume:  -     ISSN:  1365-2133     ISO Abbreviation:  Br. J. Dermatol.     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-6     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0004041     Medline TA:  Br J Dermatol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 British Association of Dermatologists.
Affiliation:
Photobiology Unit, Dermatology Centre, University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK. National Aspergillosis Centre, Education and Research Centre, University of Manchester, Manchester Academic Health Science Centre, University Hospital of South Manchester, Manchester, UK.
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