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Long-term voriconazole treatment in children linked to phototoxicity

Prolonged treatment with voriconazole in children was linked to a high rate of phototoxicity in one study.

In a retrospective analysis of 430 pediatric patients treated with voriconazole at Boston Children’s Hospital between 2003 and 2013, incidence of phototoxicity in patients whose voriconazole treatment lasted 6 months or longer was 47%. White race, cystic fibrosis, cumulative treatment time and aggregate dose were associated with phototoxicity. Mean age at initiation of voriconazole was 11.86 years.

Phototoxic reaction was defined as erythema or blistering in sun-exposed areas, cheilitis, lip cracking or lip dryness. The following coexisting medications were defined as photosensitizing: tetracyclines, fluoroquinolones, sulfonamides, tricyclic antidepressants, hydrochlorothiazide, tretinoin and methotrexate.

Nonmelanoma skin cancer was diagnosed in four patients (1%), all of whom experienced a phototoxic reaction during voriconazole treatment. Of patients who experienced a phototoxic reaction, treatment was discontinued in 5% of patients, dermatology referrals were made for 6% of patients, and 26% underwent counseling about sun protection from their primary care physician.

“We recommend counseling regarding strict photoprotection, including year-round use of broad-spectrum sunscreen and sun-protective clothing, in all patients who are prescribed voriconazole,” the authors wrote.

Disclosure: The authors have no relevant financial disclosures.