PHOTOSENSITIVITY REACTIONS

What is photosensitivity?

Photosensitivity (FOE-toe-SEN-si-TIV-I-tee) is being more sensitive than normal to light. Photosensitivity reactions include radiation enhancement (RAY-dee-AY-shuhn en-HANS-muhnt), radiation recall (RAY-dee-AY-shuhn ree-KAWL), and sunburning more easily.

Radiation enhancement and radiation recall are sunburn-type reactions which can occur when chemotherapy is given after radiation therapy, even if you never go out in the sun. Radiation enhancement can happen when you get chemotherapy at the same time or within 1 week of radiation therapy; radiation recall may occur for weeks or years after getting radiation. The radiated skin turns a pink or red color. It may also itch, peel, burn, or blister. This can last a couple hours or several days. Both these reactions can make you sunburn more easily.

Why would I have problems with photosensitivity reactions?

Chemotherapy and radiation therapy destroy cancer cells and rapidly growing normal cells, like those in the skin. These treatments also damage or slow the skin’s ability to heal. Radiation aimed at specific body parts can make these areas more sensitive to sunburn.

Chemotherapy drugs that cause photosensitivity are dacarbazine, fluorouracil (by injection or applied to skin), masoprocol (applied to skin), methotrexate, mitomycin, and vinblastine. Alitretinoin applied to the skin may make your skin sunburn more easily.

Radiation therapy can cause radiation enhancement or radiation recall with some chemotherapy drugs, such as bleomycin, dactinomycin, daunorubicin, liposomal daunorubicin, doxorubicin, liposomal doxorubicin, fluorouracil, hydroxyurea, and methotrexate. Radiation recall can also occur with etoposide, idarubicin, interferons, paclitaxel, or vinblastine.

Other factors related to cancer may cause or worsen photosensitivity including:

  • Changes in your physical appearance because of cancer or cancer treatment. Hair loss can make it easy to sunburn the top of your head.
  • Medications -- ganciclovir, some nausea medications (chlorpromazine, haloperidol, promethazine), quinolone antibiotics (ciprofloxacin, levofloxacin, ofloxacin, sparfloxacin, and others), sulfamethoxazole, and others

When should I call my doctor?

Call your doctor whenever you are worried about photosensitivity, phototoxicity, or radiation recall. Call your doctor if you have questions about your medical care.

Call the doctor as soon as you can if you have:

  • Darkening or redness of skin where radiation therapy was given
  • Blisters, sores, or peeling of skin where radiation therapy was given
  • Fever above 100.5o Fahrenheit after a sunburn
  • Symptoms of dehydration after a sunburn -- decreased urination, dizziness or light-headedness, dry mouth, increased thirst
  • Fluid-filled blisters from a sunburn
  • A sunburn that hurts so much you cannot move

How should I protect myself from these reactions?

Sunscreen

  • Wear sunscreen with a sun protection factor (SPF) of 15 or higher. Wear a higher SPF if you have fair skin or burn easily. Wear sunscreen every day during treatment, whether or not you plan to go outside. Ask your doctor or nurse if you need to wear a sunblock, like zinc oxide.
  • Apply sunscreen generously and evenly. Use lots of it before you go out in the sun.
  • Reapply sunscreen after swimming or if you sweat a lot.
  • Wear a sunblock lipstick or lip balm with an SPF of at least 15 on your lips.

Clothes

  • Wear protective clothing (long sleeves, pants), a hat, and sunglasses. Light-colored cotton or gauzy fabric may be cooler than heavier fabrics.

Other Ideas

  • If you lose some or all of your hair from chemotherapy, use sunscreen or a head covering whenever you go out in the sun. Your scalp is very sensitive to sunburn.
  • Use perfumes, deodorant, and powders with caution or not at all. Skin that is exposed to the sun may be more sensitive to sunburn if you use these products.
  • Avoid using tape or adhesive dressings on exposed skin, if you can. The adhesive may make your skin more sensitive to sunburn.
  • Avoid getting sunburned for several days before getting methotrexate. If you get a sunburn during this time, the burn may return or worsen when you start this medicine.

What should I do if I have a radiation reaction or get a sunburn?

Place a cool, wet compress over the affected area to soothe the itching and burning. Taking a cool bath may also help.

Avoid popping or opening any blisters. Open blisters can easily get infected.

What things should I AVOID so I don’t have problems with photosensitivity reactions?

  • AVOID direct sunlight, especially between 10:00 am and 4:00 pm.
  • AVOID sunlamps, tanning beds, or tanning booths.

What should I know about medicine for photosensitivity reactions and sunburns?

Medicine can be applied to the skin, taken by mouth, or injected into the veins. Ask your doctor or pharmacist which type of medicine you need.

Medicines for photosensitivity reactions and sunburns are used for:

  • Pain relief -- acetaminophen, aspirin, or ibuprofen taken by mouth; benzocaine or lidocaine applied to the skin
  • To reduce itching -- antihistamines taken by mouth or injected into the veins; corticosteroid creams applied to the skin
  • To relieve burning -- corticosteroid creams applied to the skin

Take the dose of medicine your doctor prescribes. Ask your doctor, nurse or pharmacist before changing your dose if you need more or less medicine.

These patient information materials should be used in conjunction with verbal counseling. They are not intended as the sole source of information patients receive about managing cancer therapy complications.

From the Cancer Chemotherapy Manual, © 2001, University of Utah Hospitals and Clinics, Salt Lake City, UT. Published by Facts and Comparisons, St Louis, MO, www.drugfacts.com