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Publication
Fotossensibilidade induzida por fármacos
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Authors
Advisor(s)
Abstract(s)
Introdução: A fotossensibilidade induzida por fármacos consiste numa reação cutânea anormal, em indivíduos expostos a radiação solar ou outra, causada por esses fármacos, enquanto que, na sua ausência os indivíduos tolerariam o mesmo grau de foto-exposição.
Objetivos: Identificar os fármacos promotores de reações de fotossensibilidade e reconhecer o papel do farmacêutico na gestão e prevenção das reações.
Métodos: Revisão da literatura através de pesquisa em base de dados como Pubmed, Cochrane Library e Science Direct. Foram incluídos artigos publicados até 2020, inclusive, e escritos em língua inglesa, portuguesa e espanhola.
Resultados: A prevalência das reações de fotossensibilidade depende de fatores como área geográfica e hábitos de prescrição e consumo e podem ser causadas tanto por fármacos de uso tópico, como sistémico. Várias classes farmacoterapêuticas, nomeadamente AINE (cetoprofeno e piroxicam), Antifúngicos (voriconazol), Antibióticos (tetraciclinas, fluoroquinolonas), Diuréticos (hidroclorotiazida), Estatinas (atorvastatina, fluvastatina), Anti-arritmicos (amiodarona), Retinoídes e Antineoplásicos (vemurafenib), estão entre as mais frequentemente envolvidas na indução da fotossensibilidade. A fotossensibilidade induzida por fármacos pode manifestar-se por formigueiro, queimadura, urticária, eczema, foto-onicólise, discromia, pseudoporfiria, entre outros, dependendo do tipo de reação e do fármaco responsável. A exposição crónica a estes fármacos pode estar associada a um aumento do risco de fotocarcinogenese. O diagnóstico é realizado sobretudo com base na história clínica do doente, mas pode ser auxiliado por testes epicutâneos.
Conclusões: Um grande número de fármacos, incluindo Não Sujeitos a Receita Médica, podem induzir fotossensibilidade o que implica cuidados acrescidos de fotoproteção do doente. A fotossensibilidade induzida por fármacos pode acontecer mesmo com exposição a radiação não solar e pode ter consequências graves. O farmacêutico tem um papel importante no aconselhamento, prevenção e gestão de eventuais reações cutâneas associadas a terapêuticas.
Introduction: The drug induced photosensitivity consists of an abnormal skin reaction, in individuals exposed to solar radiation or other, caused by drugs, whereas in the absence of this exposure they would tolerate the same level of photo-exposure. Objectives: Identify drugs that cause photosensitivity reactions and acknowledge the role of the pharmacist in the management and prevention of such reactions. Methods: Review of the literature by means of research in databases such as Pubmed, Cochrane Library and Science Direct. Articles dated until 2020 were included both written in English, Portuguese and Spanish. Results: The prevalence of photosensitivity reactions depends on factors such as the geographical area and prescription and use habits, and may be caused not only by topical use drugs, but also systemic ones. Various drug classes, namely NSAIDs (ketoprofen and piroxicam), Antifungals (voriconazole), Antibiotics (tetracyclines, fluoroquinolones), Diuretics (hydrochlorothiazide), Statins (atorvastatin, fluvastatin), Antiarrhythmics (amiodarone), Retinoids e Chemotherapeutics (vemurafenib), are among the most frequently associated with the induction of photosensitivity reactions. The drug induced photosensitivity may be expressed in the form of tingling, skin burn, urticaria, eczema, photoonycholysis, dyschromia, pseudoporphyria, or other, depending on the type of reaction and the drug responsible for it. The diagnosis of such reactions is carried out mostly based on the clinical record of the patient, however it may be supported by cutaneous tests. Conclusions: A wide range of drugs, including the ones not subject to medical prescription, may induce photosensitivity, meaning that additional photo-protection precautions must be applied to the patient. The drug induced photosensitivity may occur even from exposure to non-solar radiation with severe consequences. The role of the pharmacist plays an important part in the medical counselling, prevention and management of eventual cutaneous reactions associated to those therapeutics.
Introduction: The drug induced photosensitivity consists of an abnormal skin reaction, in individuals exposed to solar radiation or other, caused by drugs, whereas in the absence of this exposure they would tolerate the same level of photo-exposure. Objectives: Identify drugs that cause photosensitivity reactions and acknowledge the role of the pharmacist in the management and prevention of such reactions. Methods: Review of the literature by means of research in databases such as Pubmed, Cochrane Library and Science Direct. Articles dated until 2020 were included both written in English, Portuguese and Spanish. Results: The prevalence of photosensitivity reactions depends on factors such as the geographical area and prescription and use habits, and may be caused not only by topical use drugs, but also systemic ones. Various drug classes, namely NSAIDs (ketoprofen and piroxicam), Antifungals (voriconazole), Antibiotics (tetracyclines, fluoroquinolones), Diuretics (hydrochlorothiazide), Statins (atorvastatin, fluvastatin), Antiarrhythmics (amiodarone), Retinoids e Chemotherapeutics (vemurafenib), are among the most frequently associated with the induction of photosensitivity reactions. The drug induced photosensitivity may be expressed in the form of tingling, skin burn, urticaria, eczema, photoonycholysis, dyschromia, pseudoporphyria, or other, depending on the type of reaction and the drug responsible for it. The diagnosis of such reactions is carried out mostly based on the clinical record of the patient, however it may be supported by cutaneous tests. Conclusions: A wide range of drugs, including the ones not subject to medical prescription, may induce photosensitivity, meaning that additional photo-protection precautions must be applied to the patient. The drug induced photosensitivity may occur even from exposure to non-solar radiation with severe consequences. The role of the pharmacist plays an important part in the medical counselling, prevention and management of eventual cutaneous reactions associated to those therapeutics.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Fotossensibilidade Foto-alergia Fototoxicidade Fármacos Fotoproteção