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• W4200530711 abstract "A 16-year-old girl presented to the dermatology clinic with erythema on the dorsal aspect of her hands. She had recently visited Peru for 3 weeks, where the erythema initially started. She was taking doxycycline, 100 mg twice daily, which was prescribed for her acne, throughout her trip as her malaria prophylaxis. Findings of the physical examination revealed erythematous patches with vesicles over the dorsal aspect of the first and second digits of both hands (Figure). Further history indicated that while hiking in Peru, she was using hiking poles that positioned the affected areas in direct exposure to intense sunlight. Once malaria prophylaxis was complete, doxycycline was discontinued and amoxicillin was prescribed for acne with eventual resolution of the rash. Phototoxic reactions from doxycycline are rare, occurring in 3% of patients at a dose of 100 mg daily with significant increased incidence at greater doses.1Layton A.M. Cunliffe W.J. Phototoxic eruptions due to doxycycline—a dose-related phenomenon.Clin Exp Dermatol. 1993; 18: 425-427https://doi.org/10.1111/j.1365-2230.1993.tb02242.xCrossref PubMed Scopus (92) Google Scholar Although doxycycline can be prescribed by pediatricians for acne, tick-borne infections (Lyme disease), and inflammatory bowel disease, it also is used for malaria chemoprophylaxis for travelers because malaria is endemic in more than 90 countries with a mortality rate of up to 2.7 million people per year.2Sood S.K. Lyme disease in children.Infect Dis Clin North Am. 2015; 29: 281-294https://doi.org/10.1016/j.idc.2015.02.011Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar, 3Breton J. Kastl A. Hoffmann N. Rogers R. Grossman A.B. Mamula P. et al.Efficacy of combination antibiotic therapy for refractory pediatric inflammatory bowel Disease.Inflamm Bowel Dis. 2019; 25: 1586-1593https://doi.org/10.1093/ibd/izz006Crossref PubMed Scopus (16) Google Scholar, 4Garcia L.S. Malaria.Clin Lab Med. 2010; 30: 93-129https://doi.org/10.1016/j.cll.2009.10.001Abstract Full Text Full Text PDF PubMed Scopus (115) Google Scholar However, doxycycline requires appropriate counseling on adverse events, with emphasis on skin reactions and proper sun protection for all travelers. Phototoxic effects of doxycycline are primarily located in a photosensitive distribution with erythema, vesicles or bullae, and a burning sensation.5Goetze S. Hiernickel C. Elsner P. Phototoxicity of doxycycline: a systematic review on clinical manifestations, frequency, cofactors, and prevention.Skin Pharmacol Physiol. 2017; 30: 76-80https://doi.org/10.1159/000458761Crossref PubMed Scopus (37) Google Scholar Occasionally, lichenoid eruptions or palmoplantar involvement and photo-onycholysis may be seen as well.5Goetze S. Hiernickel C. Elsner P. Phototoxicity of doxycycline: a systematic review on clinical manifestations, frequency, cofactors, and prevention.Skin Pharmacol Physiol. 2017; 30: 76-80https://doi.org/10.1159/000458761Crossref PubMed Scopus (37) Google Scholar Patients typically exhibit pain or itching and symptoms commonly resolve 10-14 days postdiscontinuation of the medication.5Goetze S. Hiernickel C. Elsner P. Phototoxicity of doxycycline: a systematic review on clinical manifestations, frequency, cofactors, and prevention.Skin Pharmacol Physiol. 2017; 30: 76-80https://doi.org/10.1159/000458761Crossref PubMed Scopus (37) Google Scholar Patients with lighter skin tones (Fitzpatrick skin types I-III) are at an increased risk of phototoxicity than patients with darker skin tones.5Goetze S. Hiernickel C. Elsner P. Phototoxicity of doxycycline: a systematic review on clinical manifestations, frequency, cofactors, and prevention.Skin Pharmacol Physiol. 2017; 30: 76-80https://doi.org/10.1159/000458761Crossref PubMed Scopus (37) Google Scholar,6Kim W.B. Shelley A.J. Novice K. Joo J. Lim H.W. Glassman S.J. Drug-induced phototoxicity: a systematic review.J Am Acad Dermatol. 2018; 79: 1069-1075https://doi.org/10.1016/j.jaad.2018.06.061Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar Even with the risk of phototoxicity, doxycycline is important in travel medicine, as resistance to other malaria chemoprophylaxis (chloroquine, mefloquine) rises in the world.7Jong E.C. Nothdurft H.D. Current drugs for antimalarial chemoprophylaxis: a review of efficacy and safety.J Travel Med. 2001; 8: S48-S56https://doi.org/10.2310/7060.2001.23964Crossref PubMed Scopus (29) Google Scholar The photodistribution of the rash on her bilateral dorsal first and second digits likely reflects direct sun exposure on her hands from hiking poles. This case highlights the importance of comprehensive medication counseling in patients taking doxycycline, especially on proper sun protection with appropriate sunscreens, sun-avoidance behaviors, and protective clothing. Sunscreens should be broad spectrum and cover the entire UVA1 spectrum (340-400 nm) with a factor 50+ as this spectrum of wavelength tends to cause phototoxicity in patients on doxycycline.5Goetze S. Hiernickel C. Elsner P. Phototoxicity of doxycycline: a systematic review on clinical manifestations, frequency, cofactors, and prevention.Skin Pharmacol Physiol. 2017; 30: 76-80https://doi.org/10.1159/000458761Crossref PubMed Scopus (37) Google Scholar" @default.
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• W4200530711 title "Doxycycline Phototoxicity: A Cautionary Tale for Travelers" @default.
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