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Erythema multiforme photoinduced by paroxetine and herpes simplex virus

Laura Rodríguez-Pazos1, Silvia Gómez-Bernal, Iria Montero

  • 1Department of Dermatology, Faculty of Medicine, Complejo Hospitalario Universitario, Santiago de Compostela, Spain. ladrizos@hotmail.com

Photodermatology, Photoimmunology & Photomedicine
|July 7, 2011
PubMed

Insights

Photosensitive erythema multiforme (PEM) can be triggered by medications like paroxetine and infections. This case highlights a potential cross-reactivity between SSRIs and HSV in PEM development.

Area of Science:

  • Dermatology
  • Photodermatology
  • Pharmacology

Background:

  • Erythema multiforme (EM) is an acute, self-limiting skin condition often triggered by infections.
  • Photosensitive erythema multiforme (PEM) is a rare variant characterized by lesions on sun-exposed skin.
  • Drug-induced photosensitivity and infections like herpes simplex virus (HSV) are known triggers for PEM.

Observation:

  • A patient experienced two episodes of PEM.
  • The first episode was linked to paroxetine, a selective serotonin reuptake inhibitor (SSRI), and confirmed photosensitivity via photobiological studies.
  • A positive UVB photopatch test with paroxetine suggested a drug-induced reaction, possibly with cross-reactivity to duloxetine.

Findings:

  • Systemic photosensitivity, indicated by a decreased UVB minimal erythema dose (MED), was observed while the patient was taking paroxetine.
  • The UVB-MED normalized after paroxetine and duloxetine withdrawal, suggesting a drug-related photosensitivity.
  • A second PEM episode occurred following a herpes labialis relapse, with a normal UVB-MED at that time.

Implications:

  • This case is the first to report photosensitive erythema multiforme photoinduced by selective serotonin reuptake inhibitors (SSRIs).
  • The findings suggest a potential cross-reactivity between different SSRIs in inducing photosensitivity.
  • It underscores the importance of considering both drug-induced photosensitivity and infections as triggers for PEM.

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