Lupus, Lyme Disease, and Antibiotic Side-Effects
Photosensitive reactions induced by drugs can include a planus lichenoides reaction, pseudoporphyria, and even subacute cutaneous lupus erythematosus. It is easy to see, therefore, how patients and their physicians may get confused by the symptomology of Lyme disease, especially where there is already a question of the differential diagnosis of lupus. Some antibiotic ointments or creams can induce photosensitivity whilst other cases are caused by systemic medications like oral antibiotics. Doxycycline is not thought to induce photoallergic reactions or a subacute cutaneous lupus erythematosus response, although other antibiotics used for Lyme disease treatment may cause such symptoms.
Sunburn and Lyme Disease Treatment
Not all exposure to light will induce photosensitivity in Lyme disease treatment and the wavelengths that do pose problems may differ depending on the specific chemical compounds involved. Wavelengths between the 320-400nm range (ultraviolet A) and within the visible range are those most commonly implicated in drug-induced photosensitivity responses. Sometimes patients react to ultraviolet B (290-320nm) wavelengths and these are also the wavelengths responsible for sunburn and nonmelanoma skin cancer.
Lyme Disease Antibiotics and Photosensitivity
Medications that are known to cause photosensitivity reactions include the tetracycline group of antibiotics, along with fluoroquinolones, and sulfonaminde. Ciprofloxacin, ofloxacin, and levofloxacin may be used to treat Lyme disease, especially Lyme disease in a cystic form, and these types of Lyme disease antibiotics can cause a phototoxic reaction but do not cause photoallergy, lichenoid reaction, pseudoporphyria, or a lupus-like response. Sulfonamides share these characteristics with the fluoroquinolones.
Choosing Lyme Disease Antibiotics
Choosing Lyme disease antibiotics is usually based on availability, efficacy, and factors such as pregnancy, allergies, or other medications or medical conditions. Where patients are likely to experience significant sun exposure during treatment it may be wise to consider the results of a study by Luger, et al (1995) which found that 6% of patients treated for early-stage Lyme disease had photosensitivity reactions compared to 0% in those treated with cefuroxime axetil. Doxycycline triggered adverse events in 28% of patients compared to 17% of cefuroxime-treated patients, and another study found that both photosensitivity reactions and gastrointestinal disturbances .
Lyme Disease Treatment and Photosensitivity
Lyme disease patients may also be using non-steroidal anti-inflammatory medications such as ibuprofen, ketoprofen, naproxen, or celcoxib, to manage symptoms of Lyme disease and these NSAIDs can also trigger photosensitivity. Lyme disease patients may wish to switch antibiotics if a photosensitivity reaction occurs but where this continues even after switching it could be that other medications are to blame. Oral contraceptives, salicylates, and even perfume, sunscreen and other lotions can cause photosensitivity due to the inclusion of musk ambrette, 6-methylcoumarin, and para-aminobenzoic acid in their formulations.
Phototoxicity and Photoallergic Reactions
Phototoxicity is a result of the light-activated compounds triggering cell membrane damage or even DNA damage. These reactions tend to be dose-dependent and occur in most people given sufficient amounts of specific drugs. Sufferers may simply dismiss the reaction as an extreme sunburn and even compound the situation by using additional sunscreen that contains PABA. In contast, photoallergic reactions are mediated by immune system responses to the compound and look quite like contact dermatitis. Such reactions occur only in areas of skin exposed to the sun but may affect an extended area of skin if the reaction continues unchecked or is severe.
Phototoxicity and Photosensitivity
Phototoxic reactions have a high incidence, whereas photoallergic reactions are relatively rare. Where photoallergic reactions do occur, however, they are often triggered by just a small amount of the drug and light exposure; phototoxic reactions need a larger amount of the drug in general but can occur within minutes or hours, unlike photoallergic reactions which take place a day to three days after exposure.
Lyme disease patients being treated with antibiotics or who develop photosensitivity reactions which are unexplained should consult their physician to establish the cause of their symptoms. In some cases it may feel that the Lyme disease treatment is ineffective as some symptoms such as headache and light sensitivity continue; this may in fact be a response to the antibiotics themselves and it could warrant a change in treatment to avoid Lyme disease antibiotic photosensitivity reactions.
Ogrinc K, Logar M, Lotric-Furlan S, Cerar D, Ruzić-Sabljić E, Strle F., Doxycycline versus ceftriaxone for the treatment of patients with chronic Lyme borreliosis. Wien Klin Wochenschr. 2006 Nov;118(21-22):696-701.
Luger SW, Paparone P, Wormser GP, Nadelman RB, Grunwaldt E, Gomez G, Wisniewski M, Collins JJ. Comparison of cefuroxime axetil and doxycycline in treatment of patients with early Lyme disease associated with erythema migrans. Antimicrob Agents Chemother. 1995 Mar;39(3):661-7.
Strle F, Maraspin V, Lotric-Furlan S, Ruzić-Sabljić E, Cimperman J. Azithromycin and doxycycline for treatment of Borrelia culture-positive erythema migrans. Infection. 1996 Jan-Feb;24(1):64-8.