Medicines That Cause Sensitivity to Light: Before Laser, IPL and Peels

What is sensitivity to light?

Sensitivity to light (photosensitivity) is when a substance in the skin interacts with light and causes a reaction even with an amount of sun that would not normally cause harm. This substance can be a medicine taken by mouth or applied to the skin, a herbal product, a perfume or a plant sap that has got onto the skin. Most reactions are linked to the UVA part of the sun’s ultraviolet rays; with some substances, visible light can also play a role.

Not everyone who takes a medicine that causes sensitivity to light develops a reaction. Whether a reaction occurs depends on the type of medicine, the amount used, the strength and duration of the light, and the person’s skin characteristics.

What is the difference between a phototoxic and a photoallergic reaction?

The two pictures can overlap, and the distinction is made by a physician. What matters for you is to tell your physician when you notice an unusual burn or an itchy rash in the sun while using a product.

Which medicines can cause sensitivity to light?

The groups and active substances below are examples commonly mentioned in the sources; the list is not complete. Not every medicine in the same group has the same effect. You can ask your physician or pharmacist whether the medicine you use causes sensitivity to light, or read its package leaflet.

• Tetracycline-group antibiotics (for example doxycycline): these can also be used for long periods to treat acne and rosacea.
• Fluoroquinolone-group antibiotics.
• Some diuretics (water tablets), for example hydrochlorothiazide; this can also be found combined in blood pressure medicines.
• Some non-steroidal painkillers and anti-inflammatory medicines (for example naproxen, piroxicam); some of these come as gels applied to the skin.
• The heart rhythm medicine amiodarone.
• Some antifungal medicines, for example voriconazole.
• Retinoids: the oral acne medicine isotretinoin and retinoids applied to the skin.
• Herbal products: teas, capsules and oils containing St John’s wort.

Having a procedure while taking oral isotretinoin or soon after stopping it needs a separate assessment; for this, see our articles “Medical Aesthetics for People on Medication or with Chronic Conditions” and “Medical Aesthetics for Active Acne”. The use of retinoids applied to the skin is described in our article “Retinoid Guide”.

St John’s wort matters for another reason too: it not only causes sensitivity to light but can also change the effect of many medicines. Many people who do not think of herbal products as medicines forget to tell their physician about it.

Can plants cause sensitivity to light too? (Phytophotodermatitis)

Yes. If substances called furocoumarins, found in some plants, get onto the skin and the skin is then exposed to the sun, a burn reaction called phytophotodermatitis can develop. This is not an allergy but a reaction caused by direct damage. Commonly mentioned examples are lime and lemon juice, the leaves and sap of the fig tree, celery, parsnip and some perfumes containing bergamot oil; the list is not complete.

The reaction usually starts one to two days after sun exposure, with redness, burning and sometimes blisters. It often appears as streaks, drops or fingerprint shapes where the juice dripped or splashed. As it heals, it can leave brown marks that may last for months; in darker skin, these marks may be more noticeable.

This is how the topic relates to medical aesthetics: preparing drinks with lemon in the sun in the days before a procedure, or sun exposure of the neck area where perfume has been sprayed, can both trigger a reaction in the skin to be treated and make it harder to tell the cause of dark marks that develop later.

Why does it matter before laser, IPL and peels?

Laser and IPL deliver light energy to the skin; a chemical peel does not use light, but it thins the upper layer of the skin and leaves the skin less protected against the sun in the weeks after the procedure. In a person taking a medicine that causes sensitivity to light, stronger than expected redness, burns, blisters and especially dark spots are thought to be possible during or after the procedure. For this reason, physicians ask in detail about medicine and supplement use before the procedure.

Light sources differ from one another. Most lasers work at a single wavelength, and these wavelengths are mostly in the visible and infrared range. IPL, on the other hand, uses a broad range of light limited by filters. Most medicines that cause sensitivity to light are activated by UVA. So the fact that a medicine causes a reaction in the sun does not mean it carries the same risk with every laser or IPL treatment; the assessment is made according to the device and the medicine.

The weeks after the procedure also matter. Treated skin is already sensitive; sun exposure during this period while taking a medicine that causes sensitivity to light can increase the risk of dark spots. For burns and dark spots after laser and IPL, see our article “Burns and Pigmentation Changes after Laser and IPL”; for precautions specific to darker skin, see our article “Laser, IPL and Chemical Peels on Olive and Darker Skin”.

What can a physician do?

The physician makes a decision based on the type of medicine you use, how long you have been using it, the planned procedure and your skin type. Options include postponing the procedure until a short course of medicine has finished, starting with a lower energy, choosing a different method or first doing a test treatment on a small area. For medicines that are used long term and should not be stopped, a joint decision can be made after discussion with the physician who prescribed the medicine.

A test treatment (test shot) means carrying out the procedure on a small, inconspicuous area and watching the result for a few days. It does not reduce the risk to zero, but it can help to detect an unexpected reaction early.

What should you do before the procedure?

1. Prepare a list of all the medicines you use: prescription medicines, over-the-counter painkillers, creams and gels applied to the skin, vitamins, herbal teas and capsules.
2. Also write down short-term medicines you started and finished in recent weeks (for example a course of antibiotics).
3. If you have previously had an unusual burn, an itchy rash or dark marks in the sun, say so.
4. If your physician recommends postponing or a test treatment, see this as a safety measure, not a setback.
5. If a change to a medicine is needed, consult the physician who prescribed it; also tell the physician who will perform the procedure the outcome of that discussion.
6. Choose a period when you can protect yourself strictly from the sun in the weeks before and after the procedure; wash your skin after contact with plants such as lemon, lime and fig.

Sun protection after the procedure

If you are taking a medicine that causes sensitivity to light, sun protection becomes even more important in the period after the procedure. Shade, a wide-brimmed hat, covering clothing and the sunscreen your physician recommends are used together. Your physician will tell you when sunscreen can be applied to treated skin. For choosing a product and how much to apply, see our article “Sunscreen Guide”.

Which symptoms are normal, and which need a physician or emergency care?

This table is a general guide and does not make a diagnosis. If you are not sure, call the physician who performed your procedure.

What should you not do?

• Do not stop or reduce your prescription medicine on your own in order to have a procedure.
• Do not leave out herbal teas, capsules or oils without telling your physician because you think they are natural.
• While taking a medicine that causes sensitivity to light, do not sunbathe or use a sunbed before and after the procedure.
• Do not apply lemon, lime or perfume containing bergamot to the treatment area in the sun.
• Do not burst blisters that develop in the sun or pick off crusts.
• Do not use a medicine that previously caused a reaction in the sun again without telling your physician.

Limits of the evidence: evidence on whether medicines that cause sensitivity to light really increase the risk of complications from laser and IPL is limited. A review that searched the literature on this topic found no publications reporting complications after laser in people taking these medicines, and stated that the recommendations are largely based on theoretical considerations about the wavelength that activates the medicine, and on experience. Much of the information on which medicines cause sensitivity to light is also based on case reports. For this reason, approaches can differ between clinics, and you cannot be given a personal risk figure. This page is for general information and does not replace an examination.