Photobiology Unit, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Photodermatology Unit, Division of Dermatology, Department of Medicine, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Photodermatol Photoimmunol Photomed. 2022 Mar;38(2):112-122. doi: 10.1111/phpp.12724. Epub 2021 Aug 27.
BACKGROUND/PURPOSE: Tricyclic antidepressants (TCAs) are still widely used and are available to purchase without prescription in some countries. Awareness of adverse cutaneous drug reactions is essential.
We reported a case of photo-distributed hyperpigmentation due to imipramine and carried out a systematic search of the related articles using the search terms "tricyclic antidepressants" or "tricyclic antidepressive agents", and "hyperpigmentation" or "photosensitivity disorder". Fifty non-duplicate citations were identified of which 28 articles which were independently assessed in full. The review was registered in PROSPERO, CRD42018107338.
The remaining 25 articles met our inclusion criteria. Photo-distributed hyperpigmentation tricyclic antidepressant-induced photosensitivity reactions (TIPs) was the most common presentation. In 21 cases, this presented as an asymptomatic discolouration of exposed sites. Imipramine (81%), amitriptyline (9.5%), desipramine hydrochloride (4.8%) and mirtazapine (4.8%) were reported to be the culprit drugs. Nineteen were female with a mean age at presentation of 55 years. Mean duration from commencing the culprit drug until the development of discolouration was 10.4 years. Mean daily dose was 222.7 mg for imipramine. Histology was characteristic with golden-brown or brownish granules deposited in dermis. Staining for Masson-Fontana and MEL-5 was positive in all cases. Phototesting had not been done in cases prior to ours (negative 3 months after discontinuation of imipramine). Three further reports of suspected TIP presented with non-specific and eczematous eruption. The two presentations were reported along with systemic problems (thrombocytopenia and hepatic injury).
This systematic review highlights the characteristic features of exposed site hyperpigmentation of TCA-induced photosensitivity occurring after prolonged drug exposure in many cases.
背景/目的：三环类抗抑郁药（TCAs）仍被广泛应用，在一些国家可不经处方购买。了解药物的不良反应至关重要。
我们报告了一例因丙咪嗪引起的光分布性色素沉着过度病例，并使用“三环类抗抑郁药”或“三环类抗抑郁药”和“色素沉着过度”或“光敏感性障碍”等关键词进行了系统的文献检索。共确定了 50 篇非重复引文，其中 28 篇文章进行了全面评估。该综述在 PROSPERO 中进行了注册，注册号为 CRD42018107338。
其余 25 篇文章符合纳入标准。三环类抗抑郁药诱导的光敏感性反应（TIP）所致的光分布性色素沉着过度是最常见的表现。21 例表现为暴露部位无症状的变色。丙咪嗪（81%）、阿米替林（9.5%）、盐酸去甲丙咪嗪（4.8%）和米氮平（4.8%）被报告为致病药物。19 例为女性，发病时平均年龄为 55 岁。从开始使用致病药物到出现变色的平均时间为 10.4 年。丙咪嗪的平均日剂量为 222.7mg。组织学表现为真皮内沉积有金黄色或棕褐色颗粒。所有病例的 Masson-Fontana 和 MEL-5 染色均为阳性。在我们的病例之前，没有进行光过敏试验（丙咪嗪停药 3 个月后为阴性）。另外 3 例疑似 TIP 表现为非特异性和湿疹样疹。这两种表现与全身性问题（血小板减少和肝损伤）一起报告。
这项系统综述强调了 TCA 诱导的光敏感性反应中暴露部位色素沉着过度的特征，这些病例通常在长时间暴露于药物后发生。
