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ARTICLE |

A Guide to the Problem of Photosensitivity FREE

James Kalivas, MD
[+] Author Affiliations

Reprint requests to 32 Fruit St, Boston 02114 (Dr. Kalivas).


JAMA. 1969;209(11):1706-1709. doi:10.1001/jama.1969.03160240062018
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Cutaneous eruptions more or less confined to light-exposed areas are not uncommon. Despite numerous exhaustive reviews1-7 published in recent years, it is difficult for most practitioners to acquire a real diagnostic expertise in this field. Too often, the only characteristic feature in any given case is the distribution of the lesions. Hopefully, the following schemes will provide some new perspectives and helpful insights by plotting differentiating features as attributes against the primary light-sensitive dermatoses; by commenting on the more important (or more interesting) photosensitizing drugs and contactants; and, finally, by indicating which laboratory tests are likely to be of specific diagnostic value when the history and physical findings are inconclusive (as, for example, in protoporphyria).

I. The physical examination and history

B. Extrinsic photosensitivity

1. Internal agents* (drug-induced)

Sulfonamides†—uncommon with modern analogues, in contrast to the older drug, sulfanilamide

Sulfonylureas†

Thiazides,† quinethazone†—may have only pruritus in sun-exposed sites

REFERENCES

Fitzpatrick, T.B., et al:  Abnormal Reactions of Man to Light , Ann Rev Med 14:195-214, 1963;.
Kirshbaum, B.A., and Beerman, H.:  Photosensitization Due to Drugs: A Review of Some of the Recent Literature , Amer J Med Sci 248:445-468 ( (Oct) ) 1964;.
Butterworth, T., and Strean, L.P.:  Light Sensitivity and the Genodermatoses , Cutis 1:61-69 ( (March) ); 126-131 (April) 1965;.
Daniels, F., Jr.:  Diseases Caused or Aggravated by Sunlight , Med Clin N Amer 49:565-580 ( (May) ) 1965;.
Knox, J.M.; Freeman, R.G.; and Ogura, R.:  The Destructive Energy of Sunlight , Derm Int 4:205-212 ( (Oct) -Dec) 1965;.
Pillsbury, D.M., and Caro, W.A.:  The Increasing Problem of Photosensitivity , Med Clin N Amer 50:1295-1311 ( (Sept) ) 1966;.
Cripps, D.J.:  Diseases Aggravated by Sunlight , Postgrad Med 41:557-567 ( (May) ) 1967;.
Sonck, C.E.:  Über die Photosensibilität bei Lymphogranuloma inguinale: Klinische Beobachtungen ; Acta Dermatovener 22 ( (suppl 6) ):1-499, 1941;.
Cram, D.L.; Muller, S.A.; and Winkelmann, R.K.:  Ultraviolet-Induced Acantholysis in Familial Benign Chronic Pemphigus , Arch Derm 96:636-641 ( (Dec) ) 1967;.
Gallo, R.C., and Forde, D.L.:  Familial Chronic Discoid Lupus Erythematosus and Hypergammaglobulinemia , Arch Intern Med 117:627-631 ( (May) ) 1966;.
Henington. V.M., et al:  Kwashiorkor , Arch Derm 78:157-170 ( (Aug) ) 1958;.
Halvorsen, K., and Halvorsen, S.:  Hartnup Disease , Pediatrics 31:29-38 ( (Jan) ) 1963;.
Pomeroy, J., et al:  Hartnup Disorder in a New England Family , New Eng J Med 278:1214-1216 ( (May 30) ) 1968;.
El-Hefnawi, H., and El-Hawary, M.F.S.:  Chromatographic Studies of Amino Acids in Sera and Urine of Patients With Xeroderma Pigmentosum and Their Normal Relatives , Brit J Derm 75:235-244 ( (June) ) 1963;.
Lamberg, S.I.:  A New Photosensitizer: The Artificial Sweetener Cyclamate , JAMA 201:747-750 ( (Sept 4) ) 1967;.
Winkelman, N.W., Jr.:  An Appraisal of Chlorpromazine , Amer J Psychiatr 113:961-971 ( (May) ) 1957;.
Zelickson, A.S.:  Skin Changes and Chlorpromazine: Some Hazards of Long-Term Drug Therapy , JAMA 198:341-344 ( (Oct 24) ) 1966;.
Clendenning, W.E.:  Complications of Tetracycline Therapy , Arch Derm 91:628-632 ( (June) ) 1965;.
Erickson, L.R., and Peterka, E.S.:  Sunlight Sensitivity From Oral Contraceptives , JAMA 203:980-981 ( (March 11) ) 1968;.
Berlin, N.I.; Neuberger, A.; and Scott, J.J.:  The Metabolism of δ-Aminolaevulic Acid: I. Normal Pathways, Studied With the Aid of 15N , Biochem J 64:80-90 ( (Sept) ) 1956;.
Koskelo, P.; Eisalo, A.; and Toivonen, I.:  Urinary Excretion of Porphyrin Precursors and Coproporphyrin in Healthy Females on Oral Contraceptives , Brit Med J 1:652-654 ( (March 12) ) 1966;.
Granick, S.:  The Induction in Vitro of the Synthesis of δ-Aminolevulinic Acid Synthetase in Chemical Porphyria: A Response to Certain Drugs, Sex Hormones, and Foreign Chemicals , J Biol Chem 241:1359-1375 ( (March 25) ) 1966;.
De Matteis, F.:  Disturbances of Liver Porphyrin Metabolism Caused by Drugs . Pharmacol Rev 19:523-557 ( (Dec) ) 1967;.
Watson, C.J.. et al:  Griseofulvin and Porphyrin Metabolism , Arch Derm 98:451-468 ( (Nov) ) 1968;.
Harber, L.C.; Targovnik, S.E.; and Baer, R.L.:  Contact Photosensitivity Patterns to Halogenated Salicylanilides , Arch Derm 96:646-656 ( (Dec) ) 1967;.
Ison, A.E., and Tucker, J.B.:  Photosensitive Dermatitis From Soaps , New Eng J Med 278:81-84 ( (Jan 11) ) 1968;.
Epstein, J.H.; Wuepper, K.D.; and Maibach, H.I.:  Photocontact Dermatitis to Halogenated Salicylanilides and Related Compounds , Arch Derm 97:236-244 ( (March) ) 1968;.
Jillson, O.F., and Baughman, R.D.:  Contact Photodermatitis From Bithionol , Arch Derm 88:409-418 ( (Oct) ) 1963;.
Dillaha, C.J., et al:  Further Studies With Topical 5-Fluorouracil , Arch Derm 92:410-417 ( (Oct) ) 1965;.
Sams, W.M.:  Untoward Response With Topical Fluorouracil , Arch Derm 97:14-22 ( (Jan) ) 1968;.
Falkson, G., and Schulz, E.J.:  Skin Changes in Patients Treated With 5-Fluorouracil , Brit J Derm 74:229-236 ( (June) ) 1962;.
Bloom, D.:  The Syndrome of Congenital Telangiectatic Erythema and Stunted Growth , J Pediat 68:103-113 ( (Jan) ) 1966;.
Ludwig, G.D.:  Urinary Excretion of Indoles Causing False-Positive Watson—Schwartz Tests for Porphobilinogen , J Clin Invest 37:914-915 ( (June) ) 1958;.
Berger, H., and Goldberg, A.:  Hereditary Coproporphyria , Brit Med J 2:85-88 ( (July 9) ) 1955;.
Rimington, C., and Cripps, D.J.:  Biochemical and Fluorescence-Microscopy Screening-Tests for Erythropoietic Protoporphyria , Lancet 1:624-626 ( (March 20) ) 1965;.
Blank, H., et al:  Cytologic Smears in Diagnosis of Herpes Simplex, Herpes Zoster, and Varicella , JAMA 146:1410-1412 ( (Aug 11) ) 1951;.
Fardal, R.W., and Winkelmann, R.K.:  Hypersensitivity to Deoxyribonucleic Acid in Cutaneous Disease , Arch Derm 91:503-511 ( (May) ) 1965;.
Pohle, E.L., and Tuffanelli, D.L.:  Study of Cutaneous Lupus Erythematosus , Arch Derm 97:520-526 ( (May) ) 1968;.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

Fitzpatrick, T.B., et al:  Abnormal Reactions of Man to Light , Ann Rev Med 14:195-214, 1963;.
Kirshbaum, B.A., and Beerman, H.:  Photosensitization Due to Drugs: A Review of Some of the Recent Literature , Amer J Med Sci 248:445-468 ( (Oct) ) 1964;.
Butterworth, T., and Strean, L.P.:  Light Sensitivity and the Genodermatoses , Cutis 1:61-69 ( (March) ); 126-131 (April) 1965;.
Daniels, F., Jr.:  Diseases Caused or Aggravated by Sunlight , Med Clin N Amer 49:565-580 ( (May) ) 1965;.
Knox, J.M.; Freeman, R.G.; and Ogura, R.:  The Destructive Energy of Sunlight , Derm Int 4:205-212 ( (Oct) -Dec) 1965;.
Pillsbury, D.M., and Caro, W.A.:  The Increasing Problem of Photosensitivity , Med Clin N Amer 50:1295-1311 ( (Sept) ) 1966;.
Cripps, D.J.:  Diseases Aggravated by Sunlight , Postgrad Med 41:557-567 ( (May) ) 1967;.
Sonck, C.E.:  Über die Photosensibilität bei Lymphogranuloma inguinale: Klinische Beobachtungen ; Acta Dermatovener 22 ( (suppl 6) ):1-499, 1941;.
Cram, D.L.; Muller, S.A.; and Winkelmann, R.K.:  Ultraviolet-Induced Acantholysis in Familial Benign Chronic Pemphigus , Arch Derm 96:636-641 ( (Dec) ) 1967;.
Gallo, R.C., and Forde, D.L.:  Familial Chronic Discoid Lupus Erythematosus and Hypergammaglobulinemia , Arch Intern Med 117:627-631 ( (May) ) 1966;.
Henington. V.M., et al:  Kwashiorkor , Arch Derm 78:157-170 ( (Aug) ) 1958;.
Halvorsen, K., and Halvorsen, S.:  Hartnup Disease , Pediatrics 31:29-38 ( (Jan) ) 1963;.
Pomeroy, J., et al:  Hartnup Disorder in a New England Family , New Eng J Med 278:1214-1216 ( (May 30) ) 1968;.
El-Hefnawi, H., and El-Hawary, M.F.S.:  Chromatographic Studies of Amino Acids in Sera and Urine of Patients With Xeroderma Pigmentosum and Their Normal Relatives , Brit J Derm 75:235-244 ( (June) ) 1963;.
Lamberg, S.I.:  A New Photosensitizer: The Artificial Sweetener Cyclamate , JAMA 201:747-750 ( (Sept 4) ) 1967;.
Winkelman, N.W., Jr.:  An Appraisal of Chlorpromazine , Amer J Psychiatr 113:961-971 ( (May) ) 1957;.
Zelickson, A.S.:  Skin Changes and Chlorpromazine: Some Hazards of Long-Term Drug Therapy , JAMA 198:341-344 ( (Oct 24) ) 1966;.
Clendenning, W.E.:  Complications of Tetracycline Therapy , Arch Derm 91:628-632 ( (June) ) 1965;.
Erickson, L.R., and Peterka, E.S.:  Sunlight Sensitivity From Oral Contraceptives , JAMA 203:980-981 ( (March 11) ) 1968;.
Berlin, N.I.; Neuberger, A.; and Scott, J.J.:  The Metabolism of δ-Aminolaevulic Acid: I. Normal Pathways, Studied With the Aid of 15N , Biochem J 64:80-90 ( (Sept) ) 1956;.
Koskelo, P.; Eisalo, A.; and Toivonen, I.:  Urinary Excretion of Porphyrin Precursors and Coproporphyrin in Healthy Females on Oral Contraceptives , Brit Med J 1:652-654 ( (March 12) ) 1966;.
Granick, S.:  The Induction in Vitro of the Synthesis of δ-Aminolevulinic Acid Synthetase in Chemical Porphyria: A Response to Certain Drugs, Sex Hormones, and Foreign Chemicals , J Biol Chem 241:1359-1375 ( (March 25) ) 1966;.
De Matteis, F.:  Disturbances of Liver Porphyrin Metabolism Caused by Drugs . Pharmacol Rev 19:523-557 ( (Dec) ) 1967;.
Watson, C.J.. et al:  Griseofulvin and Porphyrin Metabolism , Arch Derm 98:451-468 ( (Nov) ) 1968;.
Harber, L.C.; Targovnik, S.E.; and Baer, R.L.:  Contact Photosensitivity Patterns to Halogenated Salicylanilides , Arch Derm 96:646-656 ( (Dec) ) 1967;.
Ison, A.E., and Tucker, J.B.:  Photosensitive Dermatitis From Soaps , New Eng J Med 278:81-84 ( (Jan 11) ) 1968;.
Epstein, J.H.; Wuepper, K.D.; and Maibach, H.I.:  Photocontact Dermatitis to Halogenated Salicylanilides and Related Compounds , Arch Derm 97:236-244 ( (March) ) 1968;.
Jillson, O.F., and Baughman, R.D.:  Contact Photodermatitis From Bithionol , Arch Derm 88:409-418 ( (Oct) ) 1963;.
Dillaha, C.J., et al:  Further Studies With Topical 5-Fluorouracil , Arch Derm 92:410-417 ( (Oct) ) 1965;.
Sams, W.M.:  Untoward Response With Topical Fluorouracil , Arch Derm 97:14-22 ( (Jan) ) 1968;.
Falkson, G., and Schulz, E.J.:  Skin Changes in Patients Treated With 5-Fluorouracil , Brit J Derm 74:229-236 ( (June) ) 1962;.
Bloom, D.:  The Syndrome of Congenital Telangiectatic Erythema and Stunted Growth , J Pediat 68:103-113 ( (Jan) ) 1966;.
Ludwig, G.D.:  Urinary Excretion of Indoles Causing False-Positive Watson—Schwartz Tests for Porphobilinogen , J Clin Invest 37:914-915 ( (June) ) 1958;.
Berger, H., and Goldberg, A.:  Hereditary Coproporphyria , Brit Med J 2:85-88 ( (July 9) ) 1955;.
Rimington, C., and Cripps, D.J.:  Biochemical and Fluorescence-Microscopy Screening-Tests for Erythropoietic Protoporphyria , Lancet 1:624-626 ( (March 20) ) 1965;.
Blank, H., et al:  Cytologic Smears in Diagnosis of Herpes Simplex, Herpes Zoster, and Varicella , JAMA 146:1410-1412 ( (Aug 11) ) 1951;.
Fardal, R.W., and Winkelmann, R.K.:  Hypersensitivity to Deoxyribonucleic Acid in Cutaneous Disease , Arch Derm 91:503-511 ( (May) ) 1965;.
Pohle, E.L., and Tuffanelli, D.L.:  Study of Cutaneous Lupus Erythematosus , Arch Derm 97:520-526 ( (May) ) 1968;.
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