Voriconazole is a second-generation
triazole that was approved by the Food and Drug Administration in May 2002 for treatment of severe
fungal infections. In clinical trials it demonstrated superior efficacy in addition to a survival benefit when compared with the then current treatment standard,
amphotericin B, for primary treatment of invasive
aspergillosis.
Voriconazole is a highly selective inhibitor of fungal
cytochrome P450 enzymes. Adverse cutaneous reactions have been reported, namely
cheilitis,
erythema,
discoid lupus erythematosus,
Stevens-Johnson syndrome, toxic epidermal necrolysis,
erythema multiforme, and photosensitivity reactions. We report a case of photoaging caused by
voriconazole therapy. A 15-year-old patient developed
cheilitis and
erythema over the sun-exposed areas of her body 5 weeks after beginning
voriconazole for a severe
fungal infection. The lesions showed a mild transient improvement before subsequent photodamage occurred to the back of her forearms, back of her hands, and face.
Voriconazole was discontinued once the
fungal infection had completely resolved. The patient's
blisters,
erythema, and
cheilitis resolved after discontinuation of
voriconazole. However, she was left with solar elastotic changes, multiple
lentigines, and ephelides of sun-exposed areas. These cutaneous manifestations may represent a unique adverse event caused by a new second-generation
triazole.