Photoaging and phototoxicity from long-term voriconazole treatment in a 15-year-old girl

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.