A 17-year-old girl is brought to an urgent care center for sunburn. She was jogging outside for an hour today and subsequently developed redness and pain on the exposed portion of her arms and face. The patient says, "It wasn't even that sunny today. I've been outside for a lot longer than this and have never had a sunburn this bad." Her medical history includes acne vulgaris for which she was prescribed a topical and an oral medication, neither of which she can remember by name. She does not take any other medications and has no allergies. The patient is a long-distance runner for her high school track team. She lives with her father, who has dyslipidemia. Physical examination shows numerous comedones, papules, and pustules on her face and chest. Confluent areas of erythema, warmth, and edema are present on the patient's face and upper extremities. Her left arm is shown in the image below.
Which of the following medications most likely influenced the severity of this patient's sunburn?

Question

A 17-year-old girl is brought to an urgent care center for sunburn.  She was jogging outside for an hour today and subsequently developed redness and pain on the exposed portion of her arms and face.  The patient says, "It wasn't even that sunny today.  I've been outside for a lot longer than this and have never had a sunburn this bad."  Her medical history includes acne vulgaris for which she was prescribed a topical and an oral medication, neither of which she can remember by name.  She does not take any other medications and has no allergies.  The patient is a long-distance runner for her high school track team.  She lives with her father, who has dyslipidemia.  Physical examination shows numerous comedones, papules, and pustules on her face and chest.  Confluent areas of erythema, warmth, and edema are present on the patient's face and upper extremities.  Her left arm is shown in the image below.  
Which of the following medications most likely influenced the severity of this patient's sunburn?

Quizplus · Accepted Answer

Explanation: This patient has developed an exaggerated sunburn while under treatment for inflammatory acne vulgaris. Medications used in the treatment of inflammatory acne include benzoyl peroxide, topical retinoids, and topical/oral antibiotics. The most common agent that causes significant photosensitivity is doxycycline, an oral tetracycline antibiotic. Photosensitivity can also occur with other tetracyclines (eg, minocycline), benzoyl peroxide, and retinoids. Presentation can range from a mildly erythematous rash to blistering that develops minutes to hours after skin is exposed to sunlight. Prevention includes avoidance of direct sunlight (eg, protective clothing) and use of sunscreen. Because the incidence of doxycycline photosensitivity is dose dependent, nonacute management can include decreasing the dosage or discontinuing the medication. (Choices A, B, and D) Topical azelaic acid, dapsone, and erythromycin are also used in the treatment of inflammatory acne. The most common side effects include local erythema, dryness, and pruritus. Pigment changes can also be seen with the use of azelaic acid and dapsone. Photosensitivity is not seen. (Choice E) Spironolactone is a potassium-sparing diuretic that can be used to treat acne in women through its androgen receptor-blocking effects. Dermatologic side effects are not seen. Educational objective: Oral doxycycline is used in the treatment of inflammatory acne and is a photosensitizing agent that may cause exaggerated sunburn. References: Drug-induced photosensitivity: culprit drugs, management and prevention. (http://www.ncbi.nlm.nih.gov/pubmed/21879777)

A 17-Year-Old Girl Is Brought to an Urgent Care Center