What are the treatment options for photosensitivity?

Treatment Options for Photosensitivity

The most effective treatment approach for photosensitivity is strict photoprotection combined with targeted therapies based on the specific type of photosensitivity disorder. 1

Photoprotection (First-line for all types)

• Sun avoidance strategies:

  • Seek shade, especially during peak hours (10 AM to 4 PM)
  • Remember that UV radiation can be stronger when reflected by water, sand, or snow 1

• Physical barriers:

  • Wear protective clothing covering as much skin as possible
  • Use broad-brimmed hats and UV-blocking sunglasses 1
  • Consider UV-protective clothing for severe cases

• Sunscreens:

  • Apply broad-spectrum sunscreen with SPF ≥30 1
  • Ensure sunscreen is labeled "broad spectrum" (covers UVA and UVB)
  • Reapply every 2 hours and after swimming/sweating
  • For severe photosensitivity, consider specialized formulations with higher UVA protection

Medication Management

• Identify and discontinue photosensitizing medications when possible 1, 2
  • Common culprits include:
    • Cardiovascular drugs: amiodarone, hydrochlorothiazide, furosemide
    • Antimicrobials: tetracyclines, fluoroquinolones
    • NSAIDs: naproxen, piroxicam
    • Other: retinoids, phenothiazines, hydroxychloroquine 3

Specific Treatments by Photosensitivity Type

1. Drug-Induced Photosensitivity

• Discontinue offending medication if possible 2, 4
• Topical corticosteroids for acute reactions
• Oral antihistamines for symptomatic relief of pruritus
• Severe reactions may require short course of systemic corticosteroids 2

2. Polymorphic Light Eruption (PLE)

• Prophylactic phototherapy (desensitization) in early spring 1
  • PUVA or narrowband UVB (NB-UVB) administered 2-3 times weekly for 4-6 weeks
  • Gradually increases skin tolerance to UV light
• Oral antihistamines for symptomatic relief
• For severe cases: short course of oral corticosteroids during acute flares 1

3. Chronic Actinic Dermatitis (CAD)

• Strict photoprotection
• Potent topical corticosteroids
• For severe cases: systemic immunosuppressants 1
  • Azathioprine
  • Cyclosporine
  • PUVA therapy under close supervision with corticosteroid cover 1

4. Solar Urticaria

• Non-sedating antihistamines (fexofenadine, cetirizine) 1, 5
• Determine action spectrum through phototesting to guide treatment
• PUVA therapy starting at 80% of minimum urticarial dose 1
• For refractory cases: omalizumab or cyclosporine may be considered
• In severe cases with very low minimum urticarial dose: UVA desensitization 1

5. Immune Checkpoint Inhibitor-Related Photosensitivity

• Grade 1: Continue immunotherapy with topical emollients and sunscreen
• Grade 2: Consider holding immunotherapy; use topical corticosteroids
• Grade 3: Hold immunotherapy; initiate systemic corticosteroids (1 mg/kg/day) 1

Special Considerations

• Window protection: Consider UV-filtering window films for cars and homes for severe photosensitivity 1
• Monitoring: Patients with history of drug-induced photosensitivity may need long-term surveillance for skin cancer 2
• Vitamin D supplementation: May be necessary for patients strictly avoiding sun exposure

Pitfalls and Caveats

• Failure to identify the specific type of photosensitivity can lead to ineffective treatment
• Patients often underestimate the importance of consistent photoprotection
• Some medications (especially amiodarone) can cause persistent photosensitivity for months after discontinuation 1, 2
• Phototherapy must be administered cautiously in photosensitive patients to avoid provoking reactions 1
• Patients with photosensitivity disorders should be advised against using tanning beds 1

Treatment Algorithm

1. Confirm diagnosis (consider phototesting/photopatch testing for unclear cases)
2. Eliminate triggers (discontinue photosensitizing medications if possible)
3. Implement strict photoprotection (physical barriers + sunscreen)
4. Add targeted therapy based on specific photosensitivity type
5. Consider prophylactic therapy before high-exposure seasons for recurrent disorders

By following this structured approach and addressing both prevention and treatment, most patients with photosensitivity can achieve significant improvement in their condition and quality of life.