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Reacción a la luz solar
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Reacción a la luz solar

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 FOTOSENSIBILIDAD

Las reacciones de fotosensibilidad son aquellos cuadros clínicos importantes y anormales producidos, desencadenados o agravados por la exposición a la luz, generalmente solar. A diferencia de la fototoxia, la piel reacciona de forma exagerada y no reproduce solo un aumento de la tonalidad, sino que aparecen lesiones de eccema, formación de ampollas, etc...
 


 

 
  FOTOTÓXIA

Es el aumento de absorción de la luz solar por la toma o contacto de medicamentos o productos químicos, o en ocasiones por alteraciones del metabolismo de las personas o en ciertas enfermedades. Las lesiones que se producen son las mismas que produce la exposición solar solo que más intensas y que aparecen con menor tiempo de exposición.
 
Fototoxia inducida por fármacos.

Es una reacción adversa cutánea a causa de la exposición sistémica o tópica de un fármaco y a la luz. Las sustancias químicas responsables pueden ser, además de fármacos, cosméticos o productos industriales. La reacción puede aparecer en cualquier individuo, es obligada y dosis-dependiente, y esencialmente se trata de una quemadura solar exagerada . Es más frecuente que las reacciones fotoalérgicas y puede presentarse igualmente a cualquier edad y en cualquier tipo de piel. No se observa reacción eccematosa en reacciones fototóxicas.
Los fármacos más implicados son:
ácido nalidíxico, amiodarona, captopril, clorotiacidas, etretinato, fenotiacinas (clorpromacina, prometacina, tioridacina, etc.), furosemida, griseofulvina, naproxeno,piracinamida, piroxicam, psoralenos o furocumarinas, sulfonamidas, tetraciclinas (sobre todo doxiciclina y dimetilclortetraciclina), y derivados del alquitrán.

Al eliminar el fármaco responsable, las lesiones ceden.

Fotosensibilidad inducida por fármacos.

El fármaco presente en la piel absorbe luz (especialmente rayos UVA) y forma un fotoproducto que se une a las proteínas para formar un antígeno completo, el cual produce la reacción alérgica. Las lesiones son de eccema , con picor vesículas y exudación deaparición en zonas expuestas a la luz solar, aunque si persiste la exposición se extieden a todo el cuerpo. La fotoalergia puede persistir durante meses o años a pesar de no existir contacto con la sustancia responsable.

Causantes de administración general:
fenotiacinas
sulfonamidas
grupo PARA
De administración tópica:
salicilanilidas halogenadas (desodorantes y jabones)
PABA y derivados (filtros solares)
cinamatos y benzofenonas (filtros solares)
benzocaína
neomicina
perfume de almizcle
tioureas presentes en el neopreno
Para el diagnóstico se usan pruebas epicutáneas y fotopatch test, que es la reproducción de la aplicación, a pequeñas dosis del producto sospechoso, en la piel durante 24 horas y exposición a una lampara de UVA a espectros diferentes para reproducir la lesión de eccema.

 ALERGIA FOTOSENSIBLE POR PLANTAS (Fitofotodermatitis)

Es una dermatitis causada por contacto con plantas y exposición a la luz solar. Se produce una reacción fototóxica o fotoalérgica, originada por sustancias fotosensibilizantes (furocumarinas), presentes en diversas plantas.

Plantas productoras de fitofotodermatitis

Rutáceas : Lima, naranja, naranja amarga, limón, bergamota, ruda común.
Umbelíferas: Perejil, perifollo, apio, chirivía, hinojo, eneldo, zanahorias,
Compuestas: Milenrama, aquílea y manzanilla
Crucíferas: Mostaza
Moráceas: Higueras (sólo hoja y tallo)
Ranunculáceas: Ranúnculo
Rosáceas: Agrimonia
Leguminosas: Arvejas
Hiperáceas: Hierba de San Juan

Puede aparecer a cualquier edad y raza. Las profesiones más afectadas son jardinería, horticultura, floricultura, agricultura, etc. Es más frecuente en verano. En la fase aguda aparece eritema, vesículas y ampollas con prurito, pero sin una dermatitis eccematosa.
Puede existir una pigmentación residual con formas artificiales (líneas, etc., dependiendo de algún trabajo realizado en el exterior). Las lesiones se distribuyen en áreas de contacto, sobre todo en los brazos y las piernas. La erupción aguda cede espontáneamente, pero la hiperpigmentación puede persistir semanas.Tuotromedico.com
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