Abstract • Five patients manifested cutaneous changes indistinguishable from those noted in some porphyric disorders, consisting of fragility, denudation, and blister formation of sun-exposed skin. Microscopical examination showed subepidermal bulla formation and the desposition of PAS-positive, diastase-resistant material and IgG in or around the upper dermal blood vessel walls. There was also electron microscopical evidence of vascular basal lamina reduplication and the deposition of a fine fibrillar material in and around these vessels. However, no abnormal porphyrin formation was noted. All five patients had been receiving 250 mg of tetracycline hydrochloride twice a day for at least six months and had had extensive sun exposure prior to the onset of the condition. For four patients, discontinuing the medication led to complete remission, despite subsequent sun exposure; the fifth patient was much improved, but her skin was still somewhat fragile seven months later. We concluded that these cutaneous changes resulted from a lowgrade photosensitization by tetracycline hydrochloride. (Arch Dermatol 112:661-666, 1976) References 1. Pathak MA, Epstein JH: Normal and abnormal reactions of man to light , in Fitzpatrick TB, Arndt KA, Clark WH, et al (eds): Dermatology in General Medicine . New York, McGraw-Hill Book Co Inc, 1971, pp 977-1036. 2. Epstein JH: Adverse cutaneous reactions to the sun , in Malkinson FD, Pearson RW (eds): Year Book of Dermatology . Chicago, Year Book Medical Publishers, 1971, pp 5-43. 3. Kirshbaum BA, Beerman H: Photosensitization due to drugs . Am J Med Sci 248:445-468, 1964.Crossref 4. Sams WM Jr, Epstein JH: The experimental production of drug phototoxicity in guinea pigs: I. Using sunlight . J Invest Dermatol 48:89-94, 1967. 5. Maibach HI, Sams WM Jr, Epstein JH: Screening for drug toxicity by wave lengths greater than 3,100 A . Arch Dermatol 95:12-15, 1967.Crossref 6. Stratigos JD, Magnus IA: Photosensitivity by demethylchlortetracycline and sulphanilamide . Br J Dermatol 80:391-405, 1968.Crossref 7. Kligman AM, Breit R: The identification of phototoxic drugs by human assay . J Invest Dermatol 51:90-99, 1968.Crossref 8. Segal BM: Photosensitivity, nail discoloration and onycholysis: Side effects of tetracycline therapy . Arch Intern Med 112:165-167, 1963.Crossref 9. Schorr WF, Monash S: Photo-irradiation studies of two tetracyclines . Arch Dermatol 88:440-444, 1963.Crossref 10. Cullen SI, Catalano PM, Helfman RJ: Tetracycline sun sensitivity . Arch Dermatol 93:77, 1966.Crossref 11. Chang TW, Weinstein L: Photosensitization of human cell cultures by demethylchlortetracycline . Proc Soc Exp Biol Med 116:509-512, 1964.Crossref 12. Ison AE, Davis CM: Phototoxicity of quinoline methanols and other drugs in mice and yeast . J Invest Dermatol 52:193-198, 1969. 13. Frank SB, Cohen JH, Minkin W: Photoonycholysis due to tetracycline hydrochloride and doxycycline . Arch Dermatol 103:520-521, 1971.Crossref 14. Pohle EL, Tuffanelli DL: Study of cutaneous lupus erythematosus by immunohistochemical methods . Arch Dermatol 97:520-526, 1968.Crossref 15. Tuffanelli DL, Kay D, Fukuyama K: Dermal-epidermal junction in lupus erythematosus . Arch Dermatol 99:652-662, 1969.Crossref 16. Epstein JH, Tuffanelli DL, Epstein WL: Cutaneous changes in the porphyrias: A microscopic study . Arch Dermatol 107:689-698, 1973.Crossref 17. Schwartz S, Berg MH, Bossenmaier I, Dinsmore H: Determinations of porphyrins in biological materials . Methods Biochem Anal 8:221-293, 1960. 18. Wuepper KD, Epstein JH: Erythrocyte fluorescence in relatives of patients with erythropoietic protoporphyria . JAMA 200:70-72, 1967.Crossref 19. Ramsay CA, Obreshkova E: Photosensitivity from nalidixic acid . Br J Dermatol 91:523-528, 1974.Crossref 20. Wiskerman DLA, Schulz KH: Photodermatitis caused by nalidixic acid . Hautarzt 24:445-448, 1973.
Archives of Dermatology – American Medical Association
Published: May 1, 1976