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Alexander Vincent Anstey - One of the best experts on this subject based on the ideXlab platform.
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Pellagra: a review with emphasis on Photosensitivity
The British journal of dermatology, 2011Co-Authors: P. Wan, Stuart J. Moat, Alexander Vincent AnsteyAbstract:Niacin has recently been demonstrated to lower blood pressure in hypertensive patients and to reduce cardiovascular events when combined with a statin. As a consequence, niacin has been elevated from being of historical interest as the treatment for pellagra, to being a compound with possible relevance to contemporary therapeutics. In spite of this, niacin deficiency leading to pellagra continues to be a health problem in some countries. Characterized by an exposed-site hyperpigmented dermatitis, pellagra is generally accepted to have been the first Photosensitivity syndrome described. At its worst, pellagra manifests as one of the most striking examples of systemic Photosensitivity. This is the only Photosensitivity syndrome where death is included as a cardinal clinical feature (the often quoted four 'Ds': dermatitis, diarrhoea, dementia and death). However, the pathogenetic mechanism for the Photosensitivity caused by niacin deficiency has yet to be determined. This review seeks to update the classification and phenotypic characterization of the various forms of niacin-deficient Photosensitivity. Previous speculation about possible mechanisms for the pathogenesis of Photosensitivity due to niacin deficiency is reviewed in the context of advances in the understanding of the photochemical basis of Photosensitivity reactions. The review concludes by highlighting research required to advance the understanding of this Photosensitivity syndrome.
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Congenital and acquired Photosensitivity
Medicine, 2005Co-Authors: Alexander Vincent AnsteyAbstract:Abstract Photosensitivity disorders involve abnormal sensitivity to ultra-violet and sometimes visible light. The clinical manifestations of Photosensitivity are diverse and include exaggerated sunburn response, blistering and scarring, itchy papular, eczematous or urticated eruptions, and, rarely, early onset of severe photo-damage with skin cancer. This contribution provides an overview of congenital and acquired Photosensitivity disorders, with particular emphasis on Photosensitivity as it may present to general physicians.
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Characterization of Photosensitivity in the Smith-Lemli-Opitz syndrome: a new congenital Photosensitivity syndrome.
The British journal of dermatology, 1999Co-Authors: Alexander Vincent Anstey, A. Ryan, Lesley E. Rhodes, C. R. Charman, C. F. Arlett, R. M. Tyrrell, Charles R. Taylor, Anthony D. PearseAbstract:Photosensitivity has recently been reported as a feature of the Smith-Lemli-Opitz syndrome (SLO). The aim of this study was to establish the photobiological features of this disorder and to examine the hypothesis that the Photosensitivity is caused by the high levels of 7-dehydrocholesterol found in SLO. All known cases of SLO in the U.K. were reviewed and clinical details of Photosensitivity were recorded in detail. The action spectrum of the photosensitive eruption was defined by monochromator light testing. Thirteen of the 23 subjects (57%) had severe Photosensitivity, and in 10 there was no Photosensitivity. No correlation was identified between levels of 7-dehydrocholesterol and severity of Photosensitivity, suggesting that the Photosensitivity in SLO is not caused by a direct phototoxic effect mediated by 7-dehydrocholesterol. A novel pattern of Photosensitivity was observed, with onset of a sunburn-like erythema on sun-exposed skin within minutes of sun exposure, which persisted in most cases for up to 24-48 h before fading. Monochromator light testing in three subjects showed an ultraviolet (UV) A-mediated Photosensitivity eruption with greatest Photosensitivity at 350 nm. Photosensitivity is a common and prominent feature of SLO and appears to be UVA-mediated. Elucidation of its biochemical basis may provide insight into normal cutaneous protective mechanisms against UVA-induced photodamage, and also sun sensitivity in general.
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Photosensitivity in the Smith-Lemli-Opitz syndrome: The US experience of a new congenital Photosensitivity syndrome
Journal of the American Academy of Dermatology, 1999Co-Authors: Alexander Vincent Anstey, Charles R. TaylorAbstract:Abstract Photosensitivity has been briefly mentioned in several publications on the Smith-Lemli-Opitz (SLO) syndrome, an autosomal recessive mental retardation syndrome. We conducted a questionnaire-based survey to determine the incidence and main features of Photosensitivity in SLO. We confirmed a high incidence, and initial evidence suggests that SLO may be the first example of an inherited Photosensitivity disorder in which sensitivity to UVA is common. (J Am Acad Dermatol 1999;41:121-3.)
Charles R. Taylor - One of the best experts on this subject based on the ideXlab platform.
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Characterization of Photosensitivity in the Smith-Lemli-Opitz syndrome: a new congenital Photosensitivity syndrome.
The British journal of dermatology, 1999Co-Authors: Alexander Vincent Anstey, A. Ryan, Lesley E. Rhodes, C. R. Charman, C. F. Arlett, R. M. Tyrrell, Charles R. Taylor, Anthony D. PearseAbstract:Photosensitivity has recently been reported as a feature of the Smith-Lemli-Opitz syndrome (SLO). The aim of this study was to establish the photobiological features of this disorder and to examine the hypothesis that the Photosensitivity is caused by the high levels of 7-dehydrocholesterol found in SLO. All known cases of SLO in the U.K. were reviewed and clinical details of Photosensitivity were recorded in detail. The action spectrum of the photosensitive eruption was defined by monochromator light testing. Thirteen of the 23 subjects (57%) had severe Photosensitivity, and in 10 there was no Photosensitivity. No correlation was identified between levels of 7-dehydrocholesterol and severity of Photosensitivity, suggesting that the Photosensitivity in SLO is not caused by a direct phototoxic effect mediated by 7-dehydrocholesterol. A novel pattern of Photosensitivity was observed, with onset of a sunburn-like erythema on sun-exposed skin within minutes of sun exposure, which persisted in most cases for up to 24-48 h before fading. Monochromator light testing in three subjects showed an ultraviolet (UV) A-mediated Photosensitivity eruption with greatest Photosensitivity at 350 nm. Photosensitivity is a common and prominent feature of SLO and appears to be UVA-mediated. Elucidation of its biochemical basis may provide insight into normal cutaneous protective mechanisms against UVA-induced photodamage, and also sun sensitivity in general.
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Photosensitivity in the Smith-Lemli-Opitz syndrome: The US experience of a new congenital Photosensitivity syndrome
Journal of the American Academy of Dermatology, 1999Co-Authors: Alexander Vincent Anstey, Charles R. TaylorAbstract:Abstract Photosensitivity has been briefly mentioned in several publications on the Smith-Lemli-Opitz (SLO) syndrome, an autosomal recessive mental retardation syndrome. We conducted a questionnaire-based survey to determine the incidence and main features of Photosensitivity in SLO. We confirmed a high incidence, and initial evidence suggests that SLO may be the first example of an inherited Photosensitivity disorder in which sensitivity to UVA is common. (J Am Acad Dermatol 1999;41:121-3.)
Cheryl F. Rosen - One of the best experts on this subject based on the ideXlab platform.
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Drug-Induced Photosensitivity—An Update: Culprit Drugs, Prevention and Management
Drug Safety, 2019Co-Authors: Kim M. Blakely, Aaron M. Drucker, Cheryl F. RosenAbstract:Photosensitive drug eruptions are cutaneous adverse events due to exposure to a medication and either ultraviolet or visible radiation. In this review, the diagnosis, prevention and management of drug-induced Photosensitivity is discussed. Diagnosis is based largely on the history of drug intake and the appearance of the eruption primarily affecting sun-exposed areas of the skin. This diagnosis can also be aided by tools such as phototesting, photopatch testing and rechallenge testing. The mainstay of management is prevention, including informing patients of the possibility of increased Photosensitivity as well as the use of appropriate sun protective measures. Once a Photosensitivity reaction has occurred, it may be necessary to discontinue the culprit medication and treat the reaction with corticosteroids. For certain medications, long-term surveillance may be indicated because of a higher risk of developing melanoma or squamous cell carcinoma at sites of earlier Photosensitivity reactions. A large number of medications have been implicated as causes of Photosensitivity, many with convincing clinical and scientific supporting evidence. We review the medical literature regarding the evidence for the culpability of each drug, including the results of phototesting, photopatch testing and rechallenge testing. Amiodarone, chlorpromazine, doxycycline, hydrochlorothiazide, nalidixic acid, naproxen, piroxicam, tetracycline, thioridazine, vemurafenib and voriconazole are among the most consistently implicated and warrant the most precaution by both the physician and patient.
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drug induced Photosensitivity an update culprit drugs prevention and management
Drug Safety, 2019Co-Authors: Kim Blakely, Aaron M. Drucker, Cheryl F. RosenAbstract:Photosensitive drug eruptions are cutaneous adverse events due to exposure to a medication and either ultraviolet or visible radiation. In this review, the diagnosis, prevention and management of drug-induced Photosensitivity is discussed. Diagnosis is based largely on the history of drug intake and the appearance of the eruption primarily affecting sun-exposed areas of the skin. This diagnosis can also be aided by tools such as phototesting, photopatch testing and rechallenge testing. The mainstay of management is prevention, including informing patients of the possibility of increased Photosensitivity as well as the use of appropriate sun protective measures. Once a Photosensitivity reaction has occurred, it may be necessary to discontinue the culprit medication and treat the reaction with corticosteroids. For certain medications, long-term surveillance may be indicated because of a higher risk of developing melanoma or squamous cell carcinoma at sites of earlier Photosensitivity reactions. A large number of medications have been implicated as causes of Photosensitivity, many with convincing clinical and scientific supporting evidence. We review the medical literature regarding the evidence for the culpability of each drug, including the results of phototesting, photopatch testing and rechallenge testing. Amiodarone, chlorpromazine, doxycycline, hydrochlorothiazide, nalidixic acid, naproxen, piroxicam, tetracycline, thioridazine, vemurafenib and voriconazole are among the most consistently implicated and warrant the most precaution by both the physician and patient.
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Drug-Induced Photosensitivity
Drug Safety, 2011Co-Authors: Aaron M. Drucker, Cheryl F. RosenAbstract:Photo-induced drug eruptions are cutaneous adverse events due to exposure to a drug and either ultraviolet or visible radiation. Based on their pathogenesis, they can be classified as phototoxic or photoallergic drug eruptions, although in many cases it is not possible to determine whether a particular eruption is due to a phototoxic or photoallergic mechanism. In this review, the diagnosis, prevention and management of drug-induced Photosensitivity are discussed. Diagnosis is based primarily on the history of drug intake and the clinical appearance of the eruption, primarily affecting sun-exposed areas of the skin. Phototesting and photopatch testing can be useful adjuncts in making a diagnosis. The mainstay of management is prevention, including informing patients of the possibility of increased sun sensitivity and the use of sun protective measures. However, once the eruption has occurred, it may be necessary to discontinue the culprit medication and treat the eruption with a potent topical corticosteroid. Drugs that have been implicated in causing photosensitive eruptions are reviewed. Tetracycline, doxycycline, nalidixic acid, voriconazole, amiodarone, hydrochlorothiazide, naproxen, piroxicam, chlorpromazine and thioridazine are among the most commonly implicated medications. We review the medical literature regarding evidence for the culpability of each drug, including the results of phototesting, photopatch testing and rechallenge testing.
Vincent A. Deleo - One of the best experts on this subject based on the ideXlab platform.
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Photosensitivity in lupus erythematosus
Photodermatology Photoimmunology and Photomedicine, 2004Co-Authors: Noah Scheinfeld, Vincent A. DeleoAbstract:Background: Lupus erythematosus is a systemic disease process that may manifest with a variety of internal and cutaneous findings. Photosensitivity is one the most common manifestations of lupus erythematosus. In patients with lupus erythematosus, there is a relationship between exposure to ultraviolet light, autoantibodies, genetics and other factors in the development of Photosensitivity. Methods: Literature was reviewed on the topics of lupus erythematosus and Photosensitivity discussed together and separately. The suggested mechanisms for their relationship were reviewed and analyzed. Results: Photosensitivity's relationship to and influence on the systemic manifestations of lupus remain to be defined. Mechanisms for Photosensitivity might include: modulation of autoantibody location, cytotoxic effects, apoptosis induction with autoantigens in apoptotic blebs, upregulation of adhesion molecules and cytokines, induction of nitric oxide sythase expression and ultraviolet-generated antigenic DNA. Tumor necrosis factor α also seems to play a role in the development of Photosensitivity. Conclusion: The basis for Photosensitivity in lupus has yet to be fully defined. It is more commonly associated with subacute and tumid lupus erythematosus than with other variants. Anti-Ro antibodies appear to relate to Photosensitivity. Tumor necrosis factor α polymorphisms appear to be important in some variants of lupus with Photosensitivity. There is no sin que non antibody or mutation of Photosensitivity in lupus. In patients with lupus, more work needs to be done to define the mechanisms of Photosensitivity.
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Photosensitivity in the pediatric patient.
Current opinion in pediatrics, 1997Co-Authors: Maria C. Garzon, Vincent A. DeleoAbstract:Photosensitivity in the pediatric patient is caused by a diverse group of disorders. It may indicate a serious underlying systemic disease such as lupus erythematosus or dermatomyositis, or be an early symptom of a rare group of genetic disorders that includes the porphyrias, xeroderma pigmentosum, Cockayne syndrome, Bloom syndrome, and Rothmund-Thomson syndrome. Idiopathic disorders and ultraviolet light-induced reactions to topical or systemic agents may also cause Photosensitivity in children. Early recognition and prompt diagnosis may prevent complications associated with prolonged unprotected exposure to sunlight and permit recognition of families at risk for rare heritable disorders associated with Photosensitivity.
John L M Hawk - One of the best experts on this subject based on the ideXlab platform.
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Photosensitivity Disorders
American Journal of Clinical Dermatology, 2002Co-Authors: Thomas P. Millard, John L M HawkAbstract:Abnormal Photosensitivity syndromes form a significant and common group of skin diseases. They include primary (idiopathic) photodermatoses such as polymorphic light eruption (PLE), chronic actinic dermatitis (CAD), actinic prurigo, hydroa vacciniforme and solar urticaria, in addition to drug- and chemical-induced Photosensitivity and photo-exacerbated dermatoses. They can be extremely disabling and difficult to diagnose.PLE, characterized by a recurrent pruritic papulo-vesicular eruption of affected skin within hours of sun exposure, is best managed by restriction of ultraviolet radiation (UVR) exposure and the use of high sun protection factor (SPF) sunscreens. If these measures are insufficient, prophylactic phototherapy with PUVA, broadband UVB or narrowband UVB (TL-01) for several weeks during spring may be necessary. CAD manifests as a dermatitis of chronically sun-exposed skin. Again, UVR exposure needs to be restricted; cyclosporine, azathioprine or PUVA may also be necessary. Actinic prurigo is characterized by the presence of excoriated papules and nodules on the face and limbs, most prominent and numerous distally. Actinic prurigo is managed again by restriction of UVR and the use of high SPF sunscreens; PUVA or broadband UVB therapy, or low doses of thalidomide may be necessary. Hydroa vacciniforme causes crops of discrete erythematous macules, 2 to 3mm in size, that evolve into blisters within a couple of days of sun exposure. Treatment for this rare disease is difficult; absorbent sunscreens and restricted UVR exposure may help. Solar urticaria is characterized by acute erythema and urticarial wealing after exposure to UVR. Treatment options for solar urticaria include non-sedating antihistamines such as fexofenadine and cetirizine; other options include absorbent sunscreens, restriction of UVR at the relevant wavelength, maintenance of a non-responsive state with natural or artificial light exposure and plasmapheresis.Industrial, cosmetic and therapeutic agents can induce exogenous drug- or chemical-induced Photosensitivity. The clinical pattern is highly varied, depending on the agent; treatment is based on removal of the photosensitizer along with restriction of UVR exposure.Predominantly non-photosensitive dermatoses may also be exacerbated or precipitated by UVR; exposure to UVR should be reduced and sunscreens should be advocated, along with appropriate treatment of the underlying disease.
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Photosensitivity in lupus.
Lupus, 2000Co-Authors: T P Millard, John L M Hawk, Jane M. McgregorAbstract:A wide variety of skin conditions may present in patients with lupus erythematosus (LE). These can be broadly divided into three main groups: cutaneous forms of LE ('LE-specific skin disease'), non-specific cutaneous manifestations of SLE ('LE non-specific skin disease') and cutaneous complications of drug treatments for LE. This review examines clinical Photosensitivity in LE, a trait most commonly associated with cutaneous forms of LE but which may also manifest in SLE. All humans are photosensitive, developing reddening of the skin if exposed to sufficient ultraviolet radiation (UVR). Therefore we define Photosensitivity in clinical practice as an abnormal cutaneous response to UVR. Abnormal Photosensitivity in LE may manifest in a number of different forms. The lesions of LE-specific skin disease may be induced or exacerbated by UVR. Patients with LE who are prescribed photosensitizing medications such as thiazide diuretics, neuroleptics and tetracyclines may also develop phototoxic reactions which usually present as easy sunburn. Photosensitivity may also, rarely, manifest as fragile skin and blistering in patients with both LE and porphyria cutanea tarda. Several other photosensitive disorders have been reported in association with LE, including solar urticaria and erythropoetic protoporphyria (EPP), but these appear to be chance associations. Assessment of patients with LE and Photosensitivity requires a careful history and examination. Phototesting and photoprovocation tests may be used to demonstrate Photosensitivity in some cases, but these are rarely required for diagnosis. Photosensitive patients should be advised about sun avoidance, photoprotection and sunscreen use as a first line treatment.
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Ranitidine-induced Photosensitivity
Clinical and experimental dermatology, 1995Co-Authors: P. Todd, John L M Hawk, P.g. Norris, A.w.p. Du VivierAbstract:We report the case of a 72-year-old male patient who developed a florid photosensitive eruption while on ranitidine therapy. Ultraviolet A sensitivity was detected by irradiation monochromator testing, suggesting drug-induced Photosensitivity. Ranitidine was concluded to be the cause of his Photosensitivity since the eruption resolved and the phototest abnormalities returned to normal following cessation of therapy. Similar cases have been reported to the Committee on Safety of Medicines but not published.
