Imipramine Photo.ensitivity disorder

A depressed and anxious 38·year·old white woman had developed a rash in response to a single dose of doxepin taken 2 years earlier and was then treated uneventfully with maprotiline and a ben~odiazepine . However, following a lengthy drug·free interval, the woman began taking imipramine 75mg at bedtime and, 4 days later, was admitted with a photoaggravaled cutaneous eruption.

The subject took 2 doses of imipramine and then noticed a rash on her chest and back which continued to worsen despite discontinuing imipramine, taking prednisone 60 mg/day, avoiding light and using a sunscreen containing para·aminobenzoic acid. light·exposed areas were red , abnormally hard and painful and the day before admission 'an infiltrated erythematous plaque extended over her face, upper part of her chest. and back'. Apart from the rash and an antinuclear antibody titre of 1 : 20, results of a physical examination and laboratory tests were normal. The reaction resolved slowly when the woman was placed in a dark room and treated with oral and topical steroids. She was discharged after 4 days of inpatient treatment, discontinued prednisone after a tolal 19 days of treatment, at which time a darkened environment was no longer necessary, and had clear skin on day 36. The woman visited Jamaica and Hawaii over the following year but the only flare­up occurred 3 days after discharge.

Photosensitivity reactions have been induced by tricyclic antidepressants but clinicians should be aware thaI this severe and persistent reaction. although rare, ' ... may be preventable by a careful inquiry into a history of minor reactions associated with previous tricyclic use' . Waller·Ryan. we : Kern II!. E.£.; $hirrjff, J.R. and Thomas. J-M. : Journal of the AmeriCan Medical AssoCiation 254' 351·358 (19 Jut 1985)