Chapter 8
Photosensitizers

· Photosensitivity
· Health conditions
· Medications

Photosensitivity is typically defined as a chemically induced alteration in the skin that makes a person more sensitive to light. Photosensitive reactions can fluctuate from mild to chronic depending on the sensitivity of the individual.

Understanding Photosensitivity
Many medications and topical solutions can cause the skin to burn or break out in a rash when exposed to ultraviolet light. Photosensitivity is an adverse skin reaction (dermatitis) to certain substances in the presence of ultraviolet light. The substances may be encountered orally, topically, or subcutaneously, but it must be present when the skin is exposed to ultraviolet light. Photosensitizers may cause erythema, rashes, itching, scaling or inflammation and act to decrease tolerance to ultraviolet light (TUVR) and, therefore, increase sensitivity to UVR (SUVR).

There is a list of drugs and other substances known to cause photosensitivity at the end of this chapter. The items with the highest probability of causing a reaction are highlighted. A list of this type should be clearly posted in your salon and be thoroughly reviewed by the client before they sign the informed consent form. The brand names of products should be considered only as examples; they do not represent all names under which the generic product may be sold. A document titled “Medications That Increase Sensitivity to Light: A 1990 Listing” is included in the appendix and contains almost every substance that is known to cause photosensitivity. Remind your clients to notify your tanning salon and check with their physician when they begin taking any medication while they are tanning. Clients taking psoralen drugs may become extremely photosensitive and should only tan under physician supervision. At the beginning of each new tanning season, it is a good idea to remind your clients again about the risks and symptoms of a photosensitivity reaction.

There are numerous factors that determine how a photosensitizer will react. An item which causes a severe reaction in one person may not cause but a minimal reaction in another person. Also an individual who experiences a photosensitive reaction on one occasion may not necessarily experience it again. Everyday items such as perfumes, soaps, artificial sweeteners, tattoos and certain foods may cause photosensitivity. They often cause photodermatitis, which is characterized by inflammation of the skin when exposed to ultraviolet light. Some of the new “tingle” products can cause photodermatitis and you should advise your clients to test them on a small area before using them. If a client complains of rashes and/or itching, find out whether or not they have recently used a photosensitizing substance. If so, they should be referred to a physician or pharmacist for followup.

You should exert every effort to make sure your clients thoroughly review the “Substances That May Cause Photosensitivity” list and recommend that they consult their physician prior to tanning if they are taking any of the “high probability” items. It is also wise to significantly reduce their session time temporarily if they are taking any items on the list until it can be determined whether or not it will cause the client to experience a photosensitivity reaction.

Health Conditions
The following health conditions can make tanning hazardous. Do not allow clients with these conditions to tan without written consent from their physician. (It is not likely that a doctor will permit the client to tan under these circumstances.)

AIDS / HIV (*)
Psoriasis
Albinism
Porphria
Dermatomysitis
Related Allergies
Estivalis Prurigo
Rosacea
Lichen Rubber
Solar Urticaria
Lung Tuberculosis
Sun Poisoning
Lupus Erythematosis
Varix
Melasma
Vitiligo
Photoallergic Eczema
Xeroderma Pigmentosum
Polymorphous Light Eruption
(*)Human Immunodeficiency Virus

The risk of photosensitivity and the possibility that a client may have one of the diseases listed above are but two of the many reasons why you need to routinely use a comprehensive Client Release and Informed Consent form. Never forget that you are accountable for the safety of the clients who patronize your tanning salon.

SUBSTANCES THAT MAY CAUSE PHOTOSENSITIVTY

ANTIDEPRESSANTS
clomipramine (Anafranil)
isocarboxazid (Marplan)
maprotiline (Ludiomil)
mirtazapine (Remeron)
sertaline (Zoloft)
TRICYCLIC AGENTS, eg.,Elavil, Asendin, Norpramin, Sinequan, Tofranil, Aventyl, Vivactil, Surmontil, venlafixine (Effexor)

ANTIHISTAMINES
astemizole (Hismanal)
cetirizine (Zytec)
cyproheptadine (Periactin)
dimenhydrinate (Dramamine)
diphenhydramine (Benadryl)
hydroxyzine (Atarax, Vistaril)
loratadine (Claritin)
terfenadine (Seldane)

ANTIMICROBIALS
azithromycin (Zithromax)
griseofulvin (Fulvicin, Grisactin)
*nalidixic acid (NegGram)
QUINOLONES, eg., Cipro, Penetrex,, Levaquin, Floxin, *Maxaquin, Noroxin, * Zagam sulfasalazine (Azulfidine)
* SULFONAMIDES, eg., Gantrisin, Bactrim, Septra
TETRACYCLINES, eg., *Declomycin, Vibramycin, Minocin, Terramycin

ANTIPARASITICS
*bithionol (Bitin)
chloroquine (Aralen)
mefloquine (Lariam)
pyrvinium parnoate (Povan, Vanquin)
quinine
ANTIPSYCHOTICS
chlorprothixene (Taractan, Tarasan)
haloperiodol (Haldol)

* PHENOTHIAZINES, eg., Compazine, Mellaril, Stelazine, Phenergan, Thorazine
risperidone (Risperdal)
thiothixene (Navane)

CANCER CHEMOTHERAPY
*dacarbazine (DTIC)
fluororacil (5-FU)
methotrexate (Mexate)
procarbazine (Matulane, Natulan)
vinblastine (Velban, Belbe)

CARDIOVASCULARS (see also Diuretics)
ACE INHIBITORS, eg., Capoten, Vasotec, Monapril, Accupril, Altace, Univasc
*amiodarone (Cordarone)
diltiazem (Cardizem)
disopyramide (Norpace)
losartan (Hyzaar)
lovastatin (Mevacor)
nifedipine (Procardia)
pravastin (Pravachol)
quinidine (Quinaglute)
simvastatin (Zocor)
sotalol (Betapace)

DIURETICS (see also Cardiovasculars)
acetazolamide (Diamox)
amiloride (Midamor)
furosemide (Lasix)
metolazone (Diulo, Zaroxolyn)
*THIAZIDES, eg., HydroDiuril, Naturetin,

*HYPOGLYCEMIC
SULFONYLUREAS
acetohexamide (Dymelor)
chlorpropamide (Diabinese)
glimepiride (Amaryl)
glipzide (Glucotrol)
glyburide (Diabeta, Micronase)
tolazamide (Tolinase)
tolbutamide (Orinase)

NSAIDs
All nonsteroidal anti-inflammatory drugs, eg., ibuprofen (Motrin, Naproxen (Anaprox, Naproxyn), Orudis, Feldene, Voltaren, etc. The new NSAID agents include: etodolac (Lodine), nabumetone, (Relafen), oxaprozin (Daypro)

SUNSCREENS
*benzophenones (Arimis, Clinique)
cinnamates (Arimis, Estee Lauder)
dioxbenzone (Solbar Plus)
oxybenzone (Eclipse, Presun, Shade)
PABA (PreSun)
*PABA esters
(Block Out, Sea & Ski, Eclipse)

MISCELLANEOUS
benzocaine
benzoyl peroxide (Oxy 10)
carbamazepine (Tegretol)
chlordiazepoxide (Librium)
coal tar, eg., Tegrin, Zetar)
CONTRACEPTIVES, oral estazolam (ProSom)
*etretinate (Tegison)
felbamate (Felbatol)
gabapentin (Neurontin)
gold salts (Myochrysine, Ridaura, Solganal)
hexachlorophene (pHisoHex)
hypericum (St. John’s Wort)
interferon beta-1b (Betaseron)
*isetretinoln (Accutane)
masoprocol (Actinex)
olsalazine (Dipentun)
*PERFUME OILS, eg.,
bergamot, citron, lavender, sandalwood, cedar, musk
*PSORALENS
selegiline (deprenyl, Eldepryl)
*tretinoin (Retin-A, Vitamin A Acid)
zolpidem (Ambien)

Note: Items with an asterisk (*) are shown in bold because they are more likely to cause photosensitivity reactions. Overall, the drugs listed above cause reactions in less than 1% of patients. Tell clients that get an unusual “sunburn” or allergic or eczematous reaction in skin areas exposed to light to let their physician or pharmacist know about the problem and to discontinue exposure to UV radiation. Photosensitivity data from Pharmacist’s Letter.