ABSTRACT
BACKGROUND: Phototoxicity has been attributed to numerous oral drugs over the past 60 years. OBJECTIVE: Determine the quality of evidence supporting suspected phototoxicity from oral drugs. METHODS: The MEDLINE and EMBASE databases were searched for all studies that contain original data for drug-induced phototoxicity and were published between May 1959 and December 2016. Study quality was assessed by using a modified Grading of Recommendations, Assessment, Development and Evaluation scale. RESULTS: The review included 240 eligible studies with a total of 2466 subjects. There were 1134 cases of suspected phototoxicity associated with 129 drugs. Most associations were supported by either very low-quality or low-quality evidence (89.1% of the studies). Medications supported by stronger evidence were vemurafenib, nonsteroidal anti-inflammatory drugs, and antibiotics, specifically, fluoroquinolones and tetracyclines. The most frequently reported drugs were vemurafenib, voriconazole, doxycycline, hydrochlorothiazide, amiodarone, and chlorpromazine. Photobiologic evaluation was performed in only 56 studies (23.3%), whereas challenge-rechallenge was done in 10% of cases. LIMITATIONS: Only English-language publications were reviewed. Cases of phototoxicity that had been incorrectly categorized as photoallergy would not have been included. CONCLUSIONS: Most purported associations between oral drugs and phototoxicity are not supported by high-quality evidence. Despite the variable quality of data, clinicians should be aware of the possible consequences of long-term use of culprit drugs.
Subject(s)
Dermatitis, Phototoxic/etiology , Anti-Bacterial Agents/adverse effects , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Evidence-Based Medicine , Humans , Vemurafenib/adverse effectsABSTRACT
BACKGROUND: Lupus miliaris disseminatus faciei (LMDF) is a chronic, granulomatous inflammatory disorder, commonly localized to the face. OBJECTIVE: To present an unusual manifestation of LMDF and review the literature. METHODS: We document a 41-year-old woman with LMDF with isolated axillary involvement. A literature review was conducted using Pubmed, Medline, Embase, and Google Scholar for similar cases using search terms lupus miliaris disseminatus faciei, LMDF, acne agminata, and acnitis. RESULTS: Extrafacial LMDF without concomitant facial involvement is rare; there has been only 1 other report of LMDF with exclusive axillary involvement to date. In addition, we report the successful use of doxycycline monohydrate combined with topical tacrolimus in the treatment of LMDF. CONCLUSION: Physicians should note that LMDF can occur in body sites other than the face and should be aware of the available treatment options to manage this condition.
Subject(s)
Facial Dermatoses/diagnosis , Lupus Erythematosus, Systemic/diagnosis , Rosacea/diagnosis , Adult , Axilla , Biopsy , Diagnosis, Differential , Female , HumansABSTRACT
BACKGROUND: Administrative databases provide valuable patient data and are used to conduct population-based studies. However, no studies have been conducted to validate the codes for dermatological conditions. OBJECTIVE: To evaluate the validity of ICD 9 code 706 for acne. METHODS: This was a retrospective chart review of patients seen in dermatology clinics at Sunnybrook Health Sciences Centre between March 1 and May 31, 2013. The billing code for a clinic visit was compared to the diagnosis documented in the medical chart. RESULTS: There were 4,248 participants; 201 with an ICD-9 code of acne. This code had a PPV and sensitivity with 95% confidence intervals (CI) of 84.58% (78.67-89.13%) and 86.29% (80.51-90.62%), respectively. The specificity was 99.20% (98.86-99.45%). CONCLUSIONS: We showed that ICD-9 code 706 can be used to accurately identify patients with acne in a dermatology setting. This information can be applied to future epidemiologic studies.
