Amiodarone and Facial Redness
Yes, amiodarone commonly causes facial redness (erythema) as part of its photosensitivity reaction, which occurs in over 50% of patients and typically presents as a burning, tingling sensation with associated redness in sun-exposed areas including the face. 1
Mechanism and Presentation
Photosensitivity is one of the most common dermatologic side effects of amiodarone therapy, affecting the majority of treated patients. 1, 2
The typical presentation includes burning and tingling sensations in sun-exposed skin with associated erythema (redness) that develops immediately after sun exposure. 3
The photoactivating wavelengths are primarily in the long-wave UV-A spectrum between 350 and 380 nm, making this a phototoxic reaction rather than a photoallergic one. 3
Facial redness occurs because the face is a sun-exposed area, and amiodarone accumulates in the skin along with its metabolites, making these areas particularly vulnerable to photosensitive reactions. 4
Clinical Course and Risk Factors
Younger patients (under 60 years) are at significantly higher risk for developing amiodarone-induced dermatologic adverse effects including photosensitivity. 5
The photosensitivity can persist for extended periods even after discontinuing amiodarone—in one documented case, symptoms persisted for more than 17 years after stopping the drug. 6
With continued sun exposure over months to years, 1-2% of patients may develop a distinctive blue-grey or slate-grey pigmentation on sun-exposed sites, which is a separate but related dermatologic effect. 1, 4
Management Recommendations
All patients on amiodarone must be counseled to use broad-spectrum sunblock with SPF 30 or higher and to cover exposed skin when outdoors. 1, 2
Patients should seek shade when outside, particularly around midday, and remember that UV radiation can be stronger when reflected by water, sand, or snow. 1
Prior application of a 10% dioxybenzone sunscreen has been shown to greatly reduce the phototest reaction in affected patients. 3
The photosensitivity reaction is dose-related, so dosage reduction may help if clinically feasible, though sun protection remains the primary preventive strategy. 1, 2
Important Caveats
The facial redness from photosensitivity should not be confused with the blue-grey pigmentation that can develop later with chronic therapy—these are distinct entities, though both affect sun-exposed areas. 1, 4
Even after stopping amiodarone, UV-A sensitivity may persist for weeks to months (or rarely years), so sun protection should continue during this period. 3, 6
This photosensitivity occurs in addition to amiodarone's other serious adverse effects (pulmonary, thyroid, hepatic), so dermatologic symptoms should not be dismissed as trivial. 1, 2