Фотодерматиты, вызванные применением лекарственных препаратов, являются важной и актуальной проблемой в практике врачей. Это связано с тем, что вызывать развитие фотодерматитов может целый ряд широко используемых в медицине лекарственных средств – антибиотики и сульфаниламиды, нестероидные противовоспалительные препараты, противоопухолевые препараты, диуретики, гипотензивные и антиаритмические препараты, антидиабетические и психиатрические средства, третиноин и изотретиноин, а также некоторые другие. Фотодерматиты, вызванные применением лекарственных средств, протекают по типу фототоксических реакций. Лекарственные вещества в данной ситуации в коже могут играть роль фотосенсибилизатора. Патомеханизм развития фототоксических реакций основан на накоплении в коже вещества, которое обладает свойствами фотосенсибилизатора, и одновременного воздействия на кожу солнечного излучения. Фотосенсибилизатор, повышая чувствительность кожи к видимой или ультрафиолетовой части спектра, приводит к развитию высыпаний. В своей статье мы описали случай 64-летнего пациента, у которого развился фотодерматит на фоне длительного приема амиодарона.
Drug-induced photodermatitis is an important problem in a doctor's practice. This is due to the fact that a number of drugs widely used in medicine can cause the development of photodermatitis - antibiotics and sulfonamides, non-steroidal anti-inflammatory drugs, antineoplastic drugs, diuretics, antihypertensive and antiarrhythmic drugs, antidiabetic and psychiatric drugs, tretinoin and isotretinoin, as well as some others. Drug-induced photodermatitis proceeds as phototoxic reactions. In this situation, medicinal substances in the skin can act as a photosensitizer. The pathological mechanism of development of phototoxic reactions involves both an accumulation in the skin of a substance that possess effect of a photosensitizer and the simultaneous effect of solar radiation on the skin. The photosensitizer causes rashes by increasing skin sensitivity to visible or ultraviolet part of the spectrum. This article describes the case of a 64-year-old patient who developed photodermatitis while taking amiodarone for a long time.
1. Wilm A, Berneburg M. Photoallergy. J Dtsch Dermatol Ges 2015; 13: 7–12.
2. Bylaite M, Grigaitiene J, Lapinskaite GS. Photodermatoses: classification, evaluation and management. Br J Dermatol 2009; 161 (Suppl. 3): 61–8.
3. Honari G. Photoallergy. Rev Environ Health. 2014; 29: 233–42.
4. Stein KR, Scheinfeld NS. Drug-induced photoallergic and phototoxic reactions. Expert Opin Drug Saf 2007; 6: 431–43.
5. Ladizinski B, Elpern DJ. Dronaderone-induced phototoxicity. J Drugs Dermatol 2013; 12 (8): 946–7.
6. Maoz KB, Dvash S, Brenner S, Brenner S. Amiodarone-induced skin pigmentation and multiple basal-cell carcinomas. Int J Dermatol 2009; 48 (12): 1398–400. DOI: 10.1111/j.1365-4632.2008.03819.x
7. Lankerani L, Baron ED. Photosensitivity to exogenous agents. J Cutan Med Surg 2004; 8 (6): 424–31.
8. Drucker AM, Rosen CF. Drug-induced photosensitivity: culprit drugs, management and prevention. Drug Saf 2011; 34 (10): 821–37. DOI: 10.2165/11592780-000000000-00000
9. Jaworski K, Walecka I, Rudnicka L et al. Cutaneous adverse reactions of amiodarone. Med Sci Monit 2014; 20: 2369–72. DOI: 10.12659/MSM.890881
10. Bongard V, Marc D, Philippe V et al. Incidence rate of adverse drug reactions during long-term follow-up of patients newly treated with amiodarone. Am J Ther 2006; 13 (4): 315–9.
11. Ammoury A, Michaud S, Paul C et al. Photodistribution of blue-gray hyperpigmentation after amiodarone treatment: molecular characterization of amiodarone in the skin. Arch Dermatol 2008; 144 (1): 92–6. DOI: 10.1001/archdermatol.2007.25
12. Yones SS, O'Donoghue NB, Palmer RA et al. Persistent severe amiodarone-induced photosensitivity. Clin Exp Dermatol 2005; 30 (5): 500–2.
13. Shah N, Warnakulasuriya S. Amiodarone-induced peri-oral photosensitivity. J Oral Pathol Med 2004; 33 (1): 56–8.
14. Rappersberger K, Honigsmann H, Ortel B et al. Photosensitivity and hyperpigmentation in amiodarone-treated patients: incidence, time course, and recovery. J Invest Dermatol 1989; 93: 201–9.
15. Vassallo P, Trohman RG. Prescribing amiodarone: an evidence-based review of clinical indications. JAMA 2007; 298 (11): 1312–22.
16. Ferguson J, Addo HA, Jones S et al. A study of cutanous photosensitivity induced by amiodarone. Br J Dermatol 1985; 113: 537–49.
17. Dereure O. Drug-induced skin pigmentation. Epidemiology, diagnosis and treatment. Am J Clin Dermatol 2001; 2 (4): 253–62.
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1. Wilm A, Berneburg M. Photoallergy. J Dtsch Dermatol Ges 2015; 13: 7–12.
2. Bylaite M, Grigaitiene J, Lapinskaite GS. Photodermatoses: classification, evaluation and management. Br J Dermatol 2009; 161 (Suppl. 3): 61–8.
3. Honari G. Photoallergy. Rev Environ Health. 2014; 29: 233–42.
4. Stein KR, Scheinfeld NS. Drug-induced photoallergic and phototoxic reactions. Expert Opin Drug Saf 2007; 6: 431–43.
5. Ladizinski B, Elpern DJ. Dronaderone-induced phototoxicity. J Drugs Dermatol 2013; 12 (8): 946–7.
6. Maoz KB, Dvash S, Brenner S, Brenner S. Amiodarone-induced skin pigmentation and multiple basal-cell carcinomas. Int J Dermatol 2009; 48 (12): 1398–400. DOI: 10.1111/j.1365-4632.2008.03819.x
7. Lankerani L, Baron ED. Photosensitivity to exogenous agents. J Cutan Med Surg 2004; 8 (6): 424–31.
8. Drucker AM, Rosen CF. Drug-induced photosensitivity: culprit drugs, management and prevention. Drug Saf 2011; 34 (10): 821–37. DOI: 10.2165/11592780-000000000-00000
9. Jaworski K, Walecka I, Rudnicka L et al. Cutaneous adverse reactions of amiodarone. Med Sci Monit 2014; 20: 2369–72. DOI: 10.12659/MSM.890881
10. Bongard V, Marc D, Philippe V et al. Incidence rate of adverse drug reactions during long-term follow-up of patients newly treated with amiodarone. Am J Ther 2006; 13 (4): 315–9.
11. Ammoury A, Michaud S, Paul C et al. Photodistribution of blue-gray hyperpigmentation after amiodarone treatment: molecular characterization of amiodarone in the skin. Arch Dermatol 2008; 144 (1): 92–6. DOI: 10.1001/archdermatol.2007.25
12. Yones SS, O'Donoghue NB, Palmer RA et al. Persistent severe amiodarone-induced photosensitivity. Clin Exp Dermatol 2005; 30 (5): 500–2.
13. Shah N, Warnakulasuriya S. Amiodarone-induced peri-oral photosensitivity. J Oral Pathol Med 2004; 33 (1): 56–8.
14. Rappersberger K, Honigsmann H, Ortel B et al. Photosensitivity and hyperpigmentation in amiodarone-treated patients: incidence, time course, and recovery. J Invest Dermatol 1989; 93: 201–9.
15. Vassallo P, Trohman RG. Prescribing amiodarone: an evidence-based review of clinical indications. JAMA 2007; 298 (11): 1312–22.
16. Ferguson J, Addo HA, Jones S et al. A study of cutanous photosensitivity induced by amiodarone. Br J Dermatol 1985; 113: 537–49.
17. Dereure O. Drug-induced skin pigmentation. Epidemiology, diagnosis and treatment. Am J Clin Dermatol 2001; 2 (4): 253–62.
1 ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия;
2 ГБУЗ «Московский научно-практический центр дерматовенерологии и косметологии» Департамента здравоохранения г. Москвы, Москва, Россия;
3 ФГБУН «Центр теоретических проблем физико-химической фармакологии» РАН, Москва, Россия
*marykor@bk.ru
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Zofiia A. Nevozinskaia1,2, Anastas L. Piruzian3, Irina M. Korsunskaia*3
1 Pirogov Russian National Research Medical University, Moscow, Russia;
2 Moscow Scientific and Practical Center for Dermatovenereology and Cosmetology, Moscow, Russia;
3 Center for Theoretical Problems of Physicochemical Pharmacology, Moscow, Russia
*marykor@bk.ru