Drug-induced phototoxicity: A systematic review

Area of Science:

• Dermatology
• Pharmacology
• Evidence-Based Medicine

Background:

• Phototoxicity is a known adverse effect of many oral medications.
• Over 60 years, numerous drugs have been implicated in causing photosensitivity reactions.

Purpose of the Study:

• To evaluate the evidential quality supporting suspected phototoxicity linked to oral drugs.
• To identify drugs with the strongest evidence of causing phototoxic reactions.

Main Methods:

• A systematic review of MEDLINE and EMBASE databases was conducted for studies from May 1959 to December 2016.
• Original data on drug-induced phototoxicity were included.
• Study quality was assessed using a modified Grading of Recommendations, Assessment, Development and Evaluation (GRADE) scale.

Main Results:

• The review analyzed 240 studies involving 2466 subjects and 1134 cases of suspected phototoxicity across 129 drugs.
• A significant majority of associations (89.1%) were supported by very low or low-quality evidence.
• Vemurafenib, NSAIDs, fluoroquinolones, and tetracyclines had stronger supporting evidence. Commonly reported drugs included vemurafenib, voriconazole, doxycycline, and hydrochlorothiazide.

Conclusions:

• The majority of suspected oral drug-phototoxicity links are not substantiated by high-quality evidence.
• Despite evidence limitations, awareness of potential phototoxic risks from certain oral drugs is crucial for clinicians.
• Further research may be needed to clarify the evidence base for many drug-induced phototoxicity cases.