HYANNIS – You know the routine to protect yourself before going out in the sun:
Sunscreen? Check.
Sunglasses, hat and skin-covering clothing? Check.
Limited time in the sun? Check.
Read your medication labels? What?
Many common prescriptions and over-the-counter drugs can make you more susceptible to sunburn or, less commonly, cause an allergic skin reaction to sun exposure. The list is extensive and includes some antibiotics, acne and anti-aging treatments, antidepressants, chemotherapy drugs, non-steroidal pain medications, cholesterol-lowering drugs, diabetes medicines, antifungals, birth control pills and high blood pressure medicines.
The U.S. Food and Drug Administration has a complete list.
How these drugs affect photosensitivity varies from individual to individual, and some drugs are more problematic than others, said Angela Medeiros, director of outpatient pharmacy services at Cape Cod Healthcare. This time of year, the drug Cape health professionals often warn patients about is doxycycline, an antibiotic typically given in response to a deer tick bite to treat or prevent Lyme disease, she said.
“You and I can both take doxycycline and go out into the sun and one of us could be fine and the other end up in the ER (emergency room),” Medeiros said.
Reactions Can Be Severe
While severe reactions are rare, they do occur, especially with prolonged sun exposure, she said.
“I saw a landscaper taking doxycycline. He came back the day after taking it and working outdoors all day. He was covered with blisters (caused by the sun),” she said.
Medeiros listed tetracycline, sulfa drugs and ciprofloxacin as other antibiotics that can cause sun sensitivity.
Photosensitivity can be inherited, according to the American Academy of Dermatology. People of Native American descent may be prone to a type of photoallergic reaction known as actinic prurigo, a more severe form of polymorphous light eruption (PMLE), which affects 10-15 percent of the U.S. population, according to drugs.com, of Harvard Health Publications.
Certain medical conditions may also generate photosensitivity. Lupus erythematosis, rosacea, psoriasis, HIV infection and eczema number among these illnesses, according to the National Tanning Training Institute. Ultraviolet light, present in both sunlight and artificial tanning rays, spurs the reaction. According to the institute, tanning salon staff should post a list of conditions and medications that may cause photosensitivity and tell customers with one of the listed conditions or taking one of the listed drugs to avoid tanning or contact their physician first for advice.
Medeiros also advised limiting sun exposure if you’re using topical anti-aging cosmetics or acne medicines. These often contain retinoids or salicylic acid. Retinoids and salicylic acid make skin more vulnerable to sun damage, she said.
Ironically, even some sunscreens can make you more sensitive to the sun’s rays. The Skin Cancer Foundation includes sunscreens with PABA, benzophenones and salicylates as possibly causing photosensitivity.
Two Types of Sensitivity
Photosensitive reactions are divided into two types: phototoxic, which resembles a bad sunburn, and photoallergic, which causes inflammation and a rash similar to eczema. Phototoxic reactions may occur within 30 minutes of exposure, while photoallergic reactions might not occur until days later, according to an article in pharmacytimes.com.
Photosensitive reactions aren’t limited to certain drugs and cosmetics. Some dietary supplements and foods can be culprits. According to the Skin Cancer Foundation, St. John’s Wort, used as a supplement to combat depression and anxiety, can cause a phototoxic rash. Oranges, limes, grapefruit and other citrus fruits contain psoralens, compounds that make skin more photosensitive.
Researchers at Brown University went further and found an association between drinking grapefruit juice, and to a lesser extent, orange juice, and a slightly elevated risk of malignant melanoma.
Hot weather can be a time to consider the effects of other drugs before heading outside. Anticholinergic medicines that help control overactive bladders can decrease sweating, thus raising the risk of overheating, Medeiros said. Diuretics can lead to dehydration, as they increase urination and antihistamines and antipsychotics can increase sensitivity to heat, she said.
“It’s always good to ask your pharmacist if there are any of these side effects,” Medeiros said.
Consumers should also check the warning labels on both prescription and over-the-counter medications, she added.
“The important thing is to protect yourself from the sun,” Medeiros said.
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