From antibiotics to antidepressants: drugs that can cause reactions after sun exposure

During the summer months , sun exposure increases , so it's important to protect yourself from the harmful effects of ultraviolet rays on your skin and eyes. In addition to proper sun protection, the General Council of Official Colleges of Pharmacists of Spain emphasizes caution when taking photosensitizing medications , which, when combined with solar radiation, can cause adverse reactions in the body.

Specifically, there are approximately 200 photosensitizing drugs, according to BOT PLUS , the drug database of the General Council of Colleges of Pharmacists , contained in around 4,000 presentations of drugs marketed in Spain.

Pharmacists emphasize that, of all of them, the following are among the most frequently used by the population:

• Antibiotics: fluoroquinolones, such as ciprofloxacin or levofloxacin; macrolides, such as azithromycin; tetracyclines, such as doxycycline.
• Antidepressants: duloxetine, fluoxetine, sertraline or amitriptyline.
• Nonsteroidal anti-inflammatory drugs: ibuprofen or diclofenac, among others, also including topical forms, such as creams or gels.
• Antihistamines: ebastine, loratadine, or cetirizine, including those administered topically, such as diphenhydramine, used for mosquito bites.
• Antihypertensives: angiotensin-converting enzyme inhibitors (enalapril, captopril, lisinopril, or ramipril); angiotensin II receptor antagonists (candesartan, losartan, or valsartan).
• Antipsychotics: olanzapine, aripiprazole.
• Retinoids: isotretinoin or retinoic acid.
• Hypolipidemic agents: statins (atorvastatin, lovastatin, pravastatin or simvastatin).
• Diuretics: furosemide, hydrochlorothiazide.

To this list of medications , we must add other products that can cause adverse reactions, such as certain cosmetics containing dyes, perfumes, lemon or lavender essences, or compounds like retinol or glycolic acid . In these cases, it is advisable to use them at night and apply high-quality sun protection during the day.

Type of reactions

The General Council of Pharmaceutical Colleges clarifies that photosensitizing medications can cause two types of reactions: phototoxic and photoallergic.

The former are the most common: they occur in people who use high doses of a photosensitizing drug and appear immediately after sun exposure. These lesions suggest an exaggerated sunburn, with a burning sensation and the formation of blisters or hives. Their severity varies from person to person, depending on differences in absorption and metabolism , skin type and thickness, among other factors.

On the other hand, photoallergic dermatitis, which is rarer, occurs after the application of topical medications (ointments, gels, etc.). Its origin is a photochemical reaction following exposure to solar radiation. It occurs in predisposed individuals, even with low doses of the medication, due to activation of the immune system. It manifests several hours after sun exposure (12–72 h) in the form of contact dermatitis, with an eczema-like rash, swelling, and itching , and can spread beyond the area of ​​skin exposed to the sun.

The pharmacy urges the public not to stop taking their medication on their own for fear of suffering a phototoxic or photosensitive reaction without first consulting their doctor or pharmacist. Failure to continue treatment can lead to relapses and poor control of the condition for which it was prescribed.

Pharmacists also point out that a series of basic recommendations can be followed if you are using a photosensitizing medication, including:

-Always use sufficient sunscreen with a high SPF, reapplying it every two hours and after swimming.

-Remember that you also need to protect yourself from the sun in winter , not just in summer. Patients with low phototypes (fair skin and a tendency to burn) should take extra precautions to ensure adequate sun protection.

- Avoid sun exposure during the peak hours of the day (especially between 12:00 and 16:00) or on days with a higher UV index. If exposed, protect yourself appropriately with clothing, sunglasses, a hat, etc. Especially protect sensitive areas of the skin , such as the face, neck, scalp, shoulders, décolletage, ears, hands, and insteps.

- Consult with your doctor or pharmacist if the medications you are taking contain photosensitizing agents that can induce allergies or phototoxic reactions if you sunbathe while using them. The intervention of a pharmacist provides a high level of assurance regarding the effectiveness and safety of medication treatments.

-Be alert for the slightest sign of excessive sunburn , in which case it may be necessary to consult a doctor.