Drugs That Cause Sensitivity to Sunlight

Summer is a terrific time for healthy outdoor activities, such as walking, hiking, biking or swimming, and many people take care to protect their skin from sun damage by taking precautions such as using sunscreen, staying in the shade or wearing long-sleeved clothing. Unfortunately, one risk factor is often overlooked: Some drugs can cause photosensitivity, increasing the skin’s vulnerability to sunlight.

What is photosensitivity?

Some ingredients in commonly used prescription and over-the-counter drugs, as well as in cosmetics, can make the skin more sensitive to ultraviolet (UV) radiation — either from sunlight or artificial UV light (for example, that used in tanning booths).[1] The combination of UV radiation and certain drug ingredients can trigger chemical changes in the skin that can cause a rash similar to sunburn or other skin-related adverse effects. It also can make some existing skin conditions, such as eczema, worse.[2] These skin reactions can occur when certain products are applied directly to the skin or when certain medications are swallowed or injected.

Because drug-induced sun reactions are not always recognized and reported, it is not known how prevalent photosensitivity is, and for many patients it resolves without any treatment.[3] Moreover, even if a drug is known to make skin more sensitive to UV radiation, that drug does not necessarily cause a reaction in all patients and, in some cases, a person may experience a photosensitive reaction only once and then not react upon re-exposure to the same drug.[4] Reactions also tend to be more common for patients taking a drug known to cause photosensitivity for more than six months or several such drugs concomitantly (at the same time).[5]

There are two main types of drug-induced photosensitivity.[6] The more common reaction is called phototoxicity, which is characterized by skin irritation shortly after sun exposure on the exposed parts of the body. In rare cases, phototoxic reactions also can continue long after the person has stopped taking the drug ingredient that triggered the reaction.[7] Less common is a reaction called photoallergy, which is a delayed allergic response that can occur several days after sun exposure and can even affect parts of the body that were not directly exposed to UV radiation.[8]

Although the differences between these two reactions can be difficult to identify, there are various tests that dermatologists can use to help confirm a diagnosis.[9] However, if treatment becomes necessary, phototoxic and photoallergic reactions generally are managed in a similar way. As a first step, patients may be asked to stop taking the medication that caused the skin reaction or switch to another drug. If discontinuing the treatment is not possible, limiting exposure to sunlight is strongly recommended to minimize the risk of triggering skin reactions. For some patients, treatment with topical corticosteroids such as desonide (DESOWEN, VERDESO) or clobetasol (CLOBEX, CORMAX, EMBELINE, among others) also may be recommended.

Which drugs can cause sun sensitivity?

There are many commonly used prescription and over-the-counter drugs across various drug classes that are known to cause sensitivity to sunlight. Overall, nonsteroidal anti-inflammatory drugs and antibiotics are the drug classes with the strongest evidence for such photosensitivity.[10] Other implicated drug classes include antifungals, antihypertensive drugs, abnormal heart rhythm drugs, hormonal contraceptives, antiviral drugs, cholesterol-lowering drugs, chemotherapy drugs and psychotropic medications.[11]

Across all drug classes, a systematic review identified a number of drugs that have been most consistently implicated in causing photosensitivity skin reactions, including amiodarone (NEXTERONE, PACERONE), chlorpromazine (available in generic only), doxycycline (ACTICLATE, DORYX, MONODOX, ORACEA, VIBRAMYCIN), hydrochlorothiazide (MICROZIDE), naproxen (ALEVE, ANAPROX DS, NAPRELAN, NAPROSYN), piroxicam (FELDENE), tetracycline (ACHROMYCIN V), thioridazine (available in generic only) and voriconazole (VFEND).[12] See the Table below for a longer list of examples of medications by drug class that can cause photosensitivity.

In addition, several topical drugs and cosmetics, including products sold for treating wrinkles and acne and improving skin texture (such as alpha hydroxy acids and retinoids), and in rare cases ingredients in sunscreens, can cause sun-sensitive reactions.[13],[14]

Examples of Drugs That Cause Sun Sensitivity[15],[16]

†Brand-name combination products containing other active ingredients not listed
*Designated as Limited Use by Worst Pills, Best Pills News
**Designated as Do Not Use Except For Serious Fungal Infections by Worst Pills, Best Pills News
***Designated as Do Not Use by Worst Pills, Best Pills News
****Designated as Do Not Use Except For Panic Disorder by Worst Pills, Best Pills News

What You Can Do

Do not stop taking any prescription drugs without speaking to your doctor first. If you know that you are taking a medication that can trigger photosensitivity, try to reduce exposure to sunlight to minimize your risk of skin reactions. You can, for example, limit your time spent in direct sunlight, especially between 10 a.m. and 4 p.m., and wear clothing with long sleeves as well as a wide-brimmed hat and sunglasses. Despite the rare reports of sunscreen causing photosensitive reactions, the benefits of using sunscreen to protect your skin outweigh these risks.

If you have a phototoxic or photoallergic reaction to one of your medications, discuss your symptoms with your prescribing doctor and ask if there is an alternative treatment you can try. If your skin problems persist, a dermatologist also can help to better diagnose your symptoms. Seek immediate medical attention in an emergency room if the skin reaction is severe.
 

References

[1] Food and Drug Administration. The sun and your medicine. September 25, 2015. https://www.fda.gov/drugs/special-features/sun-and-your-medicine. Accessed April 5, 2023.

[2] Murphy GM. Investigation of photosensitive disorders. Photodermatol Photoimmunol Photomed. 2004;20(6):305-311.

[3] Kim WB, Shelley AJ, Novice K, et al. Drug-induced phototoxicity: A systematic review. J Am Acad Dermatol. 2018;79(6):1069-1075.

[4] Food and Drug Administration. The sun and your medicine. September 25, 2015. https://www.fda.gov/drugs/special-features/sun-and-your-medicine. Accessed April 5, 2023.

[5] Kim WB, Shelley AJ, Novice K, et al. Drug-induced phototoxicity: A systematic review. J Am Acad Dermatol. 2018;79(6):1069-1075.

[6] Food and Drug Administration. The sun and your medicine. September 25, 2015. https://www.fda.gov/drugs/special-features/sun-and-your-medicine. Accessed April 5, 2023.

[7] Bouchez C. Sun-sensitizing drugs. WebMD. April 26, 2022. https://www.webmd.com/skin-problems-and-treatments/sun-sensitizing-drugs. Accessed April 5, 2023.

[8] Stein KR, Scheinfeld NS. Drug-induced photoallergic and phototoxic reactions. Expert Opin Drug Saf. 2007;6(4):431-443.

[9] Blakely KM, Drucker AM, Rosen CF. Drug-induced photosensitivity—an update: culprit drugs, prevention and management. Drug Saf. 2019;42(7):827-847.

[10] Kim WB, Shelley AJ, Novice K, et al. Drug-induced phototoxicity: A systematic review. J Am Acad Dermatol. 2018;79(6):1069-1075.

[11] Blakely KM, Drucker AM, Rosen CF. Drug-induced photosensitivity—an update: culprit drugs, prevention and management. Drug Saf. 2019; 42:827-847.

[12] Ibid.

[13] Food and Drug Administration. Alpha hydroxy acids. November 22, 2022. https://www.fda.gov/cosmetics/cosmetic-ingredients/alpha-hydroxy-acids. Accessed April 5, 2023.

[14] Obagi Cosmeceuticals LLC. Label: tretinoin cream. January 2021. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=745cc3ce-60b4-4479-a055-316817567949&type=display. Accessed April 5, 2023.

[15] Blakely KM, Drucker AM, Rosen CF. Drug-induced photosensitivity—an update: culprit drugs, prevention and management. Drug Saf. 2019; 42:827-847.

[16] IBM Micromedex. http://www.micromedexsolutions.com/home/dispatch. Search term: “Drugs that cause photosensitivity.” Accessed March 23, 2023.