What is the treatment for photosensitivity?

Treatment of Photosensitivity

The primary treatment for photosensitivity is strict sun avoidance combined with broad-spectrum sunscreen (SPF ≥30), protective clothing, and immediate discontinuation of any photosensitizing medications. 1, 2

Immediate Management

Identify and Remove the Trigger

• Discontinue all photosensitizing medications immediately if drug-induced photosensitivity is suspected, including tetracyclines (doxycycline), fluoroquinolones, NSAIDs, thiazide diuretics, cardiovascular medications, and antidepressants 1, 3, 4
• Review all prescription medications, over-the-counter products, and herbal supplements for photosensitizing potential 1, 3
• Avoid psoralen-containing plants and foods (celery, vegetable broths, Rutaceae extracts) for at least 2 hours before any sun exposure 5

Sun Protection Measures

• Apply broad-spectrum sunscreen with SPF ≥30 to all exposed skin areas, including hands and face 5, 1
• Wear protective clothing: long-sleeved shirts, long pants, and broad-brimmed hats 1
• Avoid sun exposure between 10 AM and 4 PM when UV radiation is most intense 1
• Use UV-blocking window films (Llumar, 3M) in vehicles if driving during peak hours 5
• Completely avoid tanning beds and sunlamps 1

Acute Symptom Management

Topical Treatment

• Apply potent topical corticosteroids to affected areas to reduce inflammation and erythema 3
• Use emollients liberally to maintain skin barrier function 5

Systemic Treatment for Specific Conditions

• Non-sedating antihistamines (fexofenadine, cetirizine) are first-line for solar urticaria 6
• Consider systemic corticosteroids for severe acute reactions 3

Phototherapy for Primary Photodermatoses

For Polymorphic Light Eruption (PLE)

• Prophylactic phototherapy with narrowband UVB (NB-UVB) for several weeks during spring can desensitize patients and prevent seasonal flares 6
• Alternative options include broadband UVB or PUVA if NB-UVB is unavailable 6
• This approach is appropriate when sunscreen and sun avoidance alone are insufficient 6

For Chronic Actinic Dermatitis (CAD)

• Strict UVR restriction is essential 6
• Consider immunosuppressive therapy with cyclosporine, azathioprine, or PUVA for refractory cases 6

For Actinic Prurigo

• High SPF sunscreens and UVR restriction are foundational 6
• Low-dose thalidomide, PUVA, or broadband UVB may be necessary for persistent disease 6

Special Considerations During Phototherapy

PUVA-Specific Precautions

If phototherapy with PUVA is used for other conditions in photosensitive patients:

• No sunlight exposure for 24 hours after PUVA treatment 5
• Wear UVA-blocking protective eyewear during and after treatment 5
• Shield nipples/areolae with broad-spectrum sunscreen (SPF ≥50) or zinc oxide paste 5
• Cover recent skin cancer sites or surgical scars completely 5
• Be aware that PUVA erythema peaks at 96 hours or later, requiring treatment intervals of at least 2-3 days 5

Drug Interactions with Phototherapy

• Reduce phototherapy dose to one-third to one-half if starting retinoids during an ongoing phototherapy course 5
• Take potentially photosensitizing medications after the phototherapy session when possible 5
• Monitor warfarin levels more frequently, as psoralens inhibit liver enzymes and increase warfarin effects 5

Monitoring and Follow-Up

Regular Surveillance

• Perform monthly skin examinations during active phototherapy 5
• Annual full-body skin examinations by a dermatologist are recommended for all patients with chronic photosensitivity 1
• Encourage patient self-examination for new or changing lesions 1

Ophthalmologic Monitoring

• Baseline and periodic eye examinations are necessary for patients receiving UVA therapy due to cataract risk 5
• Patients must wear UVA-protective eyewear during and after PUVA treatments 5

Pediatric Considerations

• Narrowband UVB is preferred over PUVA in children due to its superior safety profile and ease of administration 5
• Phototherapy is appropriate for children with refractory disease unresponsive to topical measures 5
• Address psychosocial factors, as phototherapy equipment can appear intimidating to younger patients 5
• Long-term consequences of childhood phototherapy are unknown, though increased non-melanoma skin cancer risk has been reported with PUVA in pediatric psoriasis 5

Common Pitfalls to Avoid

• Do not use topical calcineurin inhibitors concurrently with phototherapy, as manufacturers recommend limiting light exposure while using these agents 5
• Avoid assuming all photosensitivity is drug-induced; primary photodermatoses require different management strategies 6
• Remember that phototoxic reactions from tetracyclines can occur even with minimal sun exposure through car windows 2
• Do not underestimate the delayed nature of PUVA erythema, which may not peak until 96 hours post-treatment 5