Investigation of photosensitivity side effect of systemic doxycycline used in the treatment of acne vulgaris
Keywords:acne vulgaris, doxycycline, photosensitivity, acne treatment
AbstractObjective In this study, photosensitivity and other side effects due to the usage of systemic doxycycline in summer during acne treatment and whether these side effects were related to the demographic and clinical properties of the patients were investigated. Methods Before conducting the study, approval of the ethics committee of the hospital was obtained. 251 patients who applied to the dermatology outpatient clinic between 01.05.2021-30.09.2021 and were diagnosed with moderate-severe acne were included in the study. Demographic characteristic of the patients, clinical and treatment features, and development of photosensitivity or other side effects during or after the treatment were examined. Results Side effects were seen in 9 out of a total of 251 patients (3.6%). Among these patients, 5 patients (2%) had erythematous papules or plaque-like lesions on the face, and 4 patients (1.6%) had erythematous papules on the forearms. A statistically significant difference for age, sex, the severity of the disease, and treatment dose was not detected between groups classified according to the side effects (p values were respectively: 0.67, 0.058, 0.343, and 0.858). Statistically, a significant difference was found between these groups for the treatment period and usage of sun protection (p values were respectively: 0.011 and 0.003). Conclusion In patients who have erythematous papules and plaques on the face, these findings regressed with topical treatment. Therefore these findings were considered to be due to the usage of the topical acne agent. However, most patients having erythematous papules on their forearms were not using sunscreens and had personal and/or familial history of atopy. Because side effects did not require cessation of the systemic treatment and regressed with administered treatment; in the case of regular usage of sunscreen and utilization of benzoyl peroxide in combination, the photosensitivity side effect was thought to be minimal.
Tan J, Bhate KA. Global perspective on the epidemiology of acne. Br J Dermatol. 2015;172(1):3–12. doi: 10.1111/bjd.13462.
Aksu AE, Metintas S, Saracoglu ZN, Gurel G, Sabuncu I, Arikan I, et al. Acne: prevalence and relationship with dietary habits in Eskisehir, Turkey. J Eur Acad Dermatol Venereol. 2012;26(12):1503–9.
Claire Beylot. Mechanisms and causes of acne. Rev Prat. 2002 Apr 15;52(8):828-30.
Doshi A, Zaheer A, Stiller MJ. A comparison of current acne grading systems and proposal of a novel system. Int J Dermatol. 1997;36(6):416–418.
S Kc, D Karn, S Shrestha. Photo-onycholysis Following Two Weeks of Doxycyclin. J Nepal Health Res Counc. 2016 Jan;14(32):66-8.
T Badri, N Ben Tekaya, F Cherif, A Ben Osman Dhahri. Photo-onycholysis: two cases induced by doxycycline. Acta Dermatovenerol Alp Pannonica Adriat. 2004 Dec;13(4):135-6.
Anneke Passier, Astri Smits-van Herwaarden, Eugène van Puijenbroek. Photo-onycholysis associated with the use of doxycycline. BMJ. 2004 Jul 31;329(7460):265.
Ömer Faruk Elmas, Necmettin Akdeniz. A Case of Doxycyclin-induced Photo-onycholysis with Dermoscopic Features. Balkan Med J. 2020 Feb 28;37(2):113.
Massimiliano Pazzaglia, Michela Venturi, Antonella Tosti. Photo-onycholysis caused by an unusual beach game activity: a pediatric case of a side effect caused by doxycycline. Pediatr Dermatol. 2014 Jan-Feb;31(1):e26-7.
Shudeshna Nag, Miriam Weinstein, Saul Greenberg. 14-year-old boy with painful nail changes. Pediatr Rev. 2015 Mar;36(3):e8-10.
S B Frank, H J Cohen, W Minkin. Photo-onycholysis due to tetracycline hydrochloride and doxycycline. Arch Dermatol. 1971 May;103(5):520-1.
T R Cavens. Onycholysis of the thumbs probably due to a phototoxic reaction from doxycycline. Cutis. 1981;27(1):53-4.
Lisa A Carroll, Anne E Laumann. Doxycycline-induced photo-onycholysis.
J Drugs Dermatol. 2003 Dec;2(6):662-3.
Didier Rabar, Patrick Combemale, François Peyron. Doxycycline-induced photo-onycholysis. J Travel Med. 2004 Nov-Dec;11(6):386-7.
Blank H, Cullen SI, Catalano PM. Photosensitivity studies with demethylchlortetracycline and doxycycline. Arch Dermatol. 1968;97 (1):1-2.
Frost P, Weinstein GD, Gomez EC. Phototoxic potential of minocycline and doxycycline. Arch Dermatol. 1972;105(5):681-683
Bjellerup M, Ljunggren B. Double blind cross-over studies on phototoxicity to three tetracycline derivatives in human volunteers. Photodermatol. 1987;4(6):281-287.
Rosén K, Swanbeck G. Phototoxic reactions from some common drugs provoked by a high-intensity UVA lamp. Acta Derm Venereol. 1982;62(3):246-248.
Layton AM, Cunliffe WJ. Phototoxic eruptions due to doxycycline—a dose-related phenomenon. Clin Exp Dermatol. 1993;18(5):425-427.
Kus S, Yucelten D, Aytug A. Comparison of efficacy of azithromycin vs. doxycycline in the treatment of acne vulgaris. Clin Exp Dermatol. 2005;30(3):215-220.
Sanchez J, Somolinos AL, Almodovar PI, Webster G, Bradshaw M, Powala C. A randomized, double-blind, placebo-controlled trial of the combined effect of doxycycline hyclate 20-mg tablets and metronidazole 0.75% topical lotion in the treatment of rosacea. J Am Acad Dermatol. 2005;53(5):791-797.
Tuyet A Nguyen, Andrew C Krakowski. The "Heart Sign": An Early Indicator of Dose-Dependent Doxycycline-Induced Phototoxicity. Pediatr Dermatol. 2016 Mar-Apr;33(2):e69-71.
Kristen K Miller, Julie Chu, Rishi Patel, Hideko Kamino. Drug-induced subacute cutaneous lupus erythematosus related to doxycycline. Dermatol Online J. 2011 Oct 15;17(10):3.
Alexander V K, Peter Weisenseel, Michael Josef Flaig et all. Photoallergic erythroderma due to doxycycline therapy of erythema chronicum migrans. Acta Derm Venereol. 2011 Oct;91(6):734-6.
Stupica D, Lusa L, Ružić-Sabljić E, Cerar T, Strle F. Treatment of erythema Migrans with doxycycline for 10 days versus 15 days. Clin Infect Dis. 2012;55:343–50.
Dattwyler RJ. Ceftriaxone compared with doxycycline for the treatment of acute disseminated Lyme disease. N Engl J Med. 1997;37:289–94.
Strle F, Maraspin V, Lotrič-Furlan S, Ruzić-Sabljić E, Cimperman J. Azithromycin and doxycycline for treatment of Borrelia positive erythema Migrans. Infection. 1996;24:64–8
Strle F, Preac-Mursic V, Cimperman J, Ruzic E, Maraspin V, Jereb M. Azithromycin versus doxycycline for treatment of erythema migrans: clinical and microbiological findings. Infection. 1993;21:83–8.
Maša Velušček, Fajko F Bajrović, Franc Strle et all. Doxycycline-induced photosensitivity in patients treated for erythema migrans. BMC Infect Dis. 2018 Aug 3;18(1):365.
Bjellerup M, Ljunggren B. Differences in phototoxic potency should be considered when tetracyclines are prescribed during summer-time. A study on doxycycline and lymecycline in human volunteers , using an objective method for recording erythema. Br J Dermatol. 1994;130:356–60.
Keijmel SP, van Kasteren ME, Blokx WA, van der Meer JW, van Rossum M, Bleeker-Rovers CP: Cutaneous hyperpigmentation induced by doxycycline: a case series. Neth J Med. 2015, 73:37-40.
Antara Afrin, Philip R Cohen. Doxycycline-Associated Hyperpigmentation: A Case Report and Literature Review. Cureus. 2022 Apr 2;14(4):e23754.