Reactive Management for Photosensitivity

General Recommendation

Preventive measures are the key to avoiding and managing photosensitivity. Broad-spectrum sunscreen is essential, minimising sun exposure and symptomatic treatment as required.

Treatment Overview

Protection against sun exposure is recommended for all patients during treatment with multikinase inhibitors,1 but is vital for patients who develop photosensitivity.

Advise patients taking a drug with a known risk of photosensitivity to minimise sun exposure, wear UV protective clothing and use a broad-spectrum sunscreen containing titanium dioxide or zinc oxide with an SPF of at least 30.2,3 Patients should be aware that photosensitisation can occur through window glass, which does not block UVA radiation.3 For grade 3 photosensitivity reactions (blistering and extensive Erythema), oral corticosteroids are indicated together with pain control as appropriate (e.g. narcotics or NSAIDs).5 Blisters that rupture can be treated with antibacterial creams to prevent infection.4

General Recommendations2,4

  • Protective clothing and sunglasses
  • Broad-spectrum sunscreen and lip balm
  • Use mild soap substitutes
  • Emollients (water-based first)
  • Cooling gels or compresses
  • Analgesia if required
  • Topical corticosteroid
  • Antihistamines
  • Oral corticosteroid (if severe)
  • Oral analgesic (NSAID or narcotic)
  • Prevent secondary infection if blisters break (e.g. antibacterial cream)
  • Individualised treatment as appropriate
  • Minimising sun exposure

Products

  • Broad-spectrum sunscreen
  • Emollients
  • Cooling gels
  • Antihistamine
  • Topical or oral corticosteroids
  • Topical or systemic analgesics
  • Antibacterial cream

Multikinase Treatment

In the case of vandetanib, photosensitivity reactions can occur up to 4 months after discontinuation of treatment; protective measures must be maintained for at least this length of time.6

Continue with/withhold the selected Multikinase inhibitor treatment regimen, as recommended in the current and relevant SPC and according to the patient’s condition.

References

1Lacouture ME, et al. Clinical practice guidelines for the prevention and treatment of EGFR inhibitor-associated dermatologic toxicities. Support Care Cancer. 2011; 19:1079-95.
2Claveau J, et al. Metastatic melanoma: optimizing outcomes by managing dermatologic toxicities associated with novel therapies. Skin Therapy Lett. 2014; 19:1-4.
3Sinha R, et al. Cutaneous adverse events associated with vemurafenib in patients with metastatic melanoma: practical advice on diagnosis, prevention and management of the main treatment-related skin toxicities. Br J Dermatol. 2012; 167: 987-94.
4Shields KM. Drug-induced photosensitivity. Detail document #200509. Pharmacist’s Letter 2004 (May); 20: 200509
5National Institutes of Health (USA). Common Terminology Criteria for Adverse Events (NCI-CTCAE V4.03), Version 4.0, May 2009.
6Food and Drug Administration. Caprelsa® (vandetanib) Prescribing Information 2014.

Last update: 22 August 2014