Doxycycline-induced photosensitivity in patients treated for erythema migrans

Maša Velušček, Fajko F Bajrović, Franc Strle, Daša Stupica, Maša Velušček, Fajko F Bajrović, Franc Strle, Daša Stupica

Abstract

Background: Doxycycline is one of the recommended antibiotics for treating erythema migrans (EM). Since EM predominantly occurs during summer, the potential of doxycycline to induce photosensitivity is of concern. In studies on the efficacy of doxycycline for treating relatively small numbers of patients with EM, the reported frequency of photosensitivity has varied from none to 15%. The aim of this study was to elucidate the frequency and clinical symptoms of doxycycline-induced photosensitivity in a large cohort of patients with EM treated in a single medical centre.

Methods: Prospectively collected data on adverse events were analysed in adult patients with EM treated with doxycycline 100 mg twice daily for 10-15 days.

Results: Photosensitivity reactions ranging from itching and burning sensations to transient mild erythema of sun-exposed skin were documented in 16/858 (1.9, 95% CI 1.1-3.0%) patients and appeared from June to October with highest frequency in July. These adverse events were more frequent in patients treated for 14 or 15 days (16/750 [2.1%]; 95% CI 1.2-3.4%) than in those treated for 10 days (0/108 [0%]; 95% CI 0.0-3.4%); however, the difference was not significant (P = 0.24). Women were more often affected than men (13/475 [2.7%], 95% CI 1.5-4.6% versus 3/383 [0.8%], 95% CI 0.2-2.3%; P = 0.04). Of the 16 patients who developed photosensitivity, 13 did not adhere to the recommendation to avoid sun exposure. None of the patients had any long-term sequelae of photosensitivity.

Conclusions: Photosensitivity reactions in adult patients with EM treated with doxycycline 100 mg twice daily for 10-15 days occurred rarely, were not severe, and had no long-term sequelae.

Trial registration: Registered at https://ichgcp.net/clinical-trials-registry/NCT00910715" title="See in ClinicalTrials.gov">NCT00910715, May 28th 2009, NCT01163994, July 13th 2010 and NCT03584919, June 19th 2018 retrospectively registered.

Keywords: Doxycycline; Erythema migrans; Photosensitivity; Tick-borne disease.

Conflict of interest statement

All three studies from which information on doxycycline adverse events was obtained had been approved by the Medical Ethics Committee of the Ministry of Health of the Republic of Slovenia (No. 38/05/06, 36/05/09, and 83/05/10); two of the studies were registered at Not applicable.

Franc Strle is an unpaid member of the steering committee of the ESCMID Study Group on Lyme Borreliosis/ESGBOR. All the other authors report no potential conflicts.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

    1. Stanek G, Wormser GP, Gray J, Strle F. Lyme borreliosis. Lancet. 2012;379:461–473. doi: 10.1016/S0140-6736(11)60103-7.
    1. Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MC, et al. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic Anaplasmosis, and Babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006;43:1089–1134. doi: 10.1086/508667.
    1. Luger SW, Paparone P, Wormser GP, Nadelman RB, Grunwaldt E, Gomez G, et al. Comparison of cefuroxime axetil and doxycycline in treatment of patients with early Lyme disease associated with erythema migrans. Antimicrob Agents Chemother. 1995;39:661–667. doi: 10.1128/AAC.39.3.661.
    1. Nadelman RB, Luger SW, Frank E, Wisniewski M, Collins JJ, Wormser GP. Comparison of cefuroxime axetil and doxycycline in the treatment of early Lyme disease. Ann Intern Med. 1992;17:273–280. doi: 10.7326/0003-4819-117-4-273.
    1. Wormser GP, Ramanathan R, Nowakowski J, McKenna D, Holmgren D, Visintainer P, et al. Duration of antibiotic therapy for early Lyme disease. Ann Intern Med. 2003;138:697–704. doi: 10.7326/0003-4819-138-9-200305060-00005.
    1. Dattwyler RJ. Ceftriaxone compared with doxycycline for the treatment of acute disseminated Lyme disease. N Engl J Med. 1997;37:289–294. doi: 10.1056/NEJM199707313370501.
    1. Dattwyler RJ, Volkman DJ, Conaty SM, Platkin SP, Luft BJ. Amoxycillin plus probenecid versus doxycycline for treatment of erythema migrans borreliosis. Lancet. 1990;336:1404–1406. doi: 10.1016/0140-6736(90)93103-V.
    1. Massarotti EM, Luger SW, Rahn DW, Messner RP, Wong JB, Johnson RC, et al. Treatment of early Lyme disease. Am J Med. 1992;92:396–403. doi: 10.1016/0002-9343(92)90270-L.
    1. Cerar D, Cerar T, Ruzic-Sabljic E, Wormser GP, Strle F. Subjective symptoms after treatment of early Lyme disease. Am J Med. 2010;123:79–86. doi: 10.1016/j.amjmed.2009.05.011.
    1. Barsic B, Maretic T, Majerus L, Strugar J. Comparison of azithromycin and doxycycline in the treatment of erythema migrans. Infection. 2000;28:153–156. doi: 10.1007/s150100050069.
    1. Strle F, Maraspin V, Lotrič-Furlan S, Ruzić-Sabljić E, Cimperman J. Azithromycin and doxycycline for treatment of Borrelia positive erythema Migrans. Infection. 1996;24:64–68. doi: 10.1007/BF01780661.
    1. Strle F, Preac-Mursic V, Cimperman J, Ruzic E, Maraspin V, Jereb M. Azithromycin versus doxycycline for treatment of erythema migrans: clinical and microbiological findings. Infection. 1993;21:83–88. doi: 10.1007/BF01710737.
    1. Strle F, Ruzic E, Cimperman J. Erythema migrans: comparison of treatment with azithromycin, doxycycline and phenoxymethylpenicillin. J Antimicrob Chemother. 1992;30:543–550. doi: 10.1093/jac/30.4.543.
    1. Stupica D, Lusa L, Ružić-Sabljić E, Cerar T, Strle F. Treatment of erythema Migrans with doxycycline for 10 days versus 15 days. Clin Infect Dis. 2012;55:343–350. doi: 10.1093/cid/cis402.
    1. Goetze S, Hiernickel C, Elsner P. Phototoxicity of doxycycline: a systematic review on clinical manifestations, frequency, cofactors, and prevention. Skin Pharmacol Physiol. 2017;30:76–80. doi: 10.1159/000458761.
    1. Stanek G, Fingerle V, Hunfeld K-P, Jaulhac B, Kaiser R, Krause A, et al. Lyme borreliosis: clinical case definitions for diagnosis and management in Europe. Clin Microbiol Infect. 2011;17:69–79. doi: 10.1111/j.1469-0691.2010.03175.x.
    1. Bjellerup M, Ljunggren B. Differences in phototoxic potency should be considered when tetracyclines are prescribed during summer-time. A study on doxycycline and lymecycline in human volunteers , using an objective method for recording erythema. Br J Dermatol. 1994;130:356–360. doi: 10.1111/j.1365-2133.1994.tb02933.x.
    1. Layton AM, Cunliffe WJ. Phototoxic eruptions due to doxycycline ─ a dose-related phenomenon. Clin Exp Dermatol. 1993;18:425–427. doi: 10.1111/j.1365-2230.1993.tb02242.x.
    1. Gomes ER, Demoly P. Epidemiology of hypersensitivity drug reactions. Curr Opin Allergy Clin Immunol. 2005;5:309–316. doi: 10.1097/01.all.0000173785.81024.33.
    1. Doernberg SB, Winston LG, Deck DH, Chambers HF. Does doxycycline protect against development of Clostridium difficile infection? Clin Infect Dis. 2012;55:615–620. doi: 10.1093/cid/cis457.
    1. Lebrun-Vignes B, Kreft-Jais C, Castot A, Chosidow O. French network of regional centers of Pharmacovigilance. Comparative analysis of adverse drug reactions to tetracyclines: results of a French national survey and review of the literature. Br J Dermatol. 2012;166:1333–1341. doi: 10.1111/j.1365-2133.2012.10845.x.
    1. de Oliveira SV, Guimarães JN, Reckziegel GC, Neves BM, Araújo-Vilges KM, Fonseca LX, et al. An update on the epidemiological situation of spotted fever in Brazil. J Venom Anim Toxins Incl Trop Dis. 2016;22:22. doi: 10.1186/s40409-016-0077-4.

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