title: Voriconazole phototoxicity in children: a retrospective review.
abstract: BACKGROUND
  Voriconazole, an antifungal agent, is associated with various cutaneous reactions, including phototoxicity, accelerated photoaging, and skin cancer. Incidence and risk factors for these reactions in children have not been well described.
  
  
  OBJECTIVE
  We sought to determine the incidence of and factors associated with phototoxic reactions and nonmelanoma skin cancer in pediatric patients treated with voriconazole.
  
  
  METHODS
  This was a retrospective analysis of 430 pediatric patients treated with voriconazole between 2003 and 2013 at Boston Children's Hospital.
  
  
  RESULTS
  Incidence of phototoxicity was 20% in all children treated with voriconazole and 47% in children treated for 6 months or longer. Factors associated with phototoxicity included white race, cystic fibrosis, cumulative treatment time, and cumulative dose. Four patients (1%) had nonmelanoma skin cancer; all experienced a phototoxic reaction during voriconazole treatment. Of those with phototoxicity, 5% were discontinued on voriconazole, 6% were referred to dermatology, and 26% received counseling about sun protection from their primary physician.
  
  
  CONCLUSIONS
  Our study is limited by its retrospective design and potential referral bias associated with a tertiary-care center.
  
  
  CONCLUSIONS
  Voriconazole-associated phototoxicity is relatively common in children and may lead to nonmelanoma skin cancer. However, those with phototoxic reactions are often continued on therapy, rarely referred to dermatology, and infrequently counseled on sun protection.
authors.affiliation: Harvard Medical School, Boston, Massachusetts; Dermatology Program, Division of Allergy and Immunology, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Johanna
authors.initials: J
authors.lastname: Sheu
authors.affiliation: Harvard Medical School, Boston, Massachusetts; Dermatology Program, Division of Allergy and Immunology, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Elena B
authors.initials: EB
authors.lastname: Hawryluk
authors.affiliation: Division of Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Dongjing
authors.initials: D
authors.lastname: Guo
authors.affiliation: Harvard Medical School, Boston, Massachusetts; Division of Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Wendy B
authors.initials: WB
authors.lastname: London
authors.affiliation: Harvard Medical School, Boston, Massachusetts; Dermatology Program, Division of Allergy and Immunology, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts. Electronic address: jennifer.huang@childrens.harvard.edu.
authors.forename: Jennifer T
authors.initials: JT
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D000935:Antifungal Agents / Q000009:adverse effects*; D001900:Boston; D002294:Carcinoma, Squamous Cell / Q000139:chemically induced / Q000453:epidemiology*; D015984:Causality; D002648:Child; D015897:Comorbidity; D003550:Cystic Fibrosis / Q000453:epidemiology; D017484:Dermatitis, Phototoxic / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D008297:Male; D009181:Mycoses / Q000188:drug therapy; D012189:Retrospective Studies; D012307:Risk Factors; D012878:Skin Neoplasms / Q000139:chemically induced* / Q000453:epidemiology*; D065819:Voriconazole / Q000009:adverse effects*; D044465:White People / Q000706:statistics & numerical data
chemical_list: D000935:Antifungal Agents; D065819:Voriconazole
keywords: nonmelanoma skin cancer; pediatrics; photosensitivity; phototoxicity; squamous cell cancer; voriconazole