Carolinas Research Day 2021

Clinical Case-Based Studies

11 Phototoxic Dermatitis

Cary Pellizzeri, OMSIII & Lindsey Tijiattas-Saleski, DO, MBA, FACOEP

Edward Via College of Osteopathic Medicine-Carolinas, Prisma Health

Introduction: Phototoxic reactions to sunlight can be attributed to many different exogenous agents. Topical creams, plants, and systemic medications can all cause photosensitivity. Among them, doxycycline is one of the most common causes of phototoxic reactions in conjunction with exposure to ultraviolet (UV) light. Because photodermatoses present similarly – sunburn-like sensations, burning and erythema on sun exposed areas, progressing to erythematous plaques adjacent to small papules – it is important to be able to identify the root cause of the phototoxic reaction for proper treatment. The goal of this presentation is to create a differential of phototoxic reactions; including, but not limited to, phototoxicity, photoallergy, phytophotodermatitis and their treatments.

Case Study: A 48-year-old female presented to the emergency department with a rash. She had been started on doxycycline the day prior for sinusitis. After being exposed to the sun while working in her yard, she noticed an erythematous, pruritic, painful rash on the sun exposed areas of her face and arms. The severity was described to be worse than a typical sun burn. She presented to the ED with concerns that this was an allergic reaction. She had stable vital signs and no other systemic symptoms. She denied fevers, chills, rash on palms or soles, lesions on mucus membranes, gastrointestinal symptoms, or previous episodes of similar. The offending agent was discontinued, and another antibiotic was imitated for her sinusitis. Sun exposure was limited temporarily. Corticosteroids can be considered for more severe reactions if needed.

Discussion: This patient had a common presentation from an uncommon cause. While she was being treated for a minor case of sinusitis, she felt well enough to spend time outdoors, gardening. The presence of confounding causes makes an accurate differential crucial to starting appropriate treatment before the photodermatosis progresses. In addition, it is important to consider not only the disease, but the patients’ activities and lifestyle when selecting medications for various ailments. Familiarity with the adverse effects of commonly prescribed medications, especially in the urgent care/emergent care settings where all information, such as medication lists and full patient history, may not be available can prevent situations such as this.

58