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Phototoxic and Photoallergic Contact Reactions

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Book cover Contact Dermatitis

Abstract

Photosensitivity is a skin reaction to light, mostly to UV light, due to the presence of endogenous or exogenous chromophores in the dermis or epidermis. Photoactive molecules in products applied to the skin or systemic drugs are frequent causes of photosensitivity. Most reactions involve non-specific cutaneous inflammation – phototoxicity – but hypersensitivity to the chemicals or their photoproducts, namely, a T-cell-mediated reaction, can also develop – photoallergy. Often both mechanisms coexist, and a non-specific phototoxic inflammation favors sensitization to the photoactive product, with possible further consequences (recognition of chemically related compounds, life-long immunologic memory, and possible progression to persistent light reactivity).

Clinical presentation of phototoxic and photoallergic reactions is highly variable both on their time course and lesional morphology: urticaria or eczema on sun-exposed areas, exaggerated sunburn, linear phytophotodermatitis, pseudoporphyria, photoonycholysis, hypo- or hyperpigmentation, and less frequently erythema multiforme, lupus erythematosus, and lichenoid reactions. Precancerous lesions and skin cancers are also increasingly associated with chronic exposure to photoactive chemicals.

Chemicals responsible for photosensitivity change with time due to recognition and elimination of important hazards and depend on regional exposure habits. Around the world, most frequent causes of exogenous photosensitivity are furocoumarins from plants, UV absorbers in sunscreens and cosmetics, and topical and systemic drugs (NSAIDs, antimicrobials, phenothiazines, anticancer drugs).

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Authors and Affiliations

  1. Clinic of Dermatology, Faculty of Medicine, Coimbra University Hospital, University of Coimbra, Coimbra, Portugal

    Margarida Gonçalo

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  1. Margarida Gonçalo
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  1. Department of Dermatology and Allergy National Allergy Research Centre Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark

    Jeanne Duus Johansen

  2. Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany

    Vera Mahler

  3. Laboratoire de Dermatochimie, University of Strasbourg, Strasbourg, France

    Jean-Pierre Lepoittevin

  4. Professor emeritus Formerly Department of Dermatology, Klinikum Dortmund, Dortmund, Germany

    Peter J. Frosch

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Gonçalo, M. (2021). Phototoxic and Photoallergic Contact Reactions. In: Johansen, J.D., Mahler, V., Lepoittevin, JP., Frosch, P.J. (eds) Contact Dermatitis. Springer, Cham. https://doi.org/10.1007/978-3-030-36335-2_18

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