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Posaconazole Substitution for Voriconazole-Associated Phototoxic Effects

Audrey A. Jacobsen, BA1; Yotam B. Papo, MD, MPH2; Robert Sarro, MD3; Kurt Weisse, MD2; John Strasswimmer, MD, PhD4
[+] Author Affiliations
1University of Miami Miller School of Medicine, Miami, Florida
2Florida Atlantic University Internal Medicine Residency Program, Boca Raton
3Dermatology Associates of the Palm Beaches Inc, Delray Beach, Florida
4Dermatology Residency Program, Broward Health, Ft Lauderdale, Florida
JAMA Dermatol. 2016;152(7):839-841. doi:10.1001/jamadermatol.2016.0345.
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This case report describes the use of posaconazole as a substitute for voriconazole after emergence of voriconazole-associated phototoxic effects.

Voriconazole is used for long-term prophylaxis or treatment of fungal infections. Voriconazole-induced phototoxic effects and photocarcinogenesis is an independent risk factor for squamous cell carcinoma (SCC) development in organ transplant recipients.1 An alternative for patients at risk for cutaneous cancer has not been well studied. We describe a patient with voriconazole-induced photocarcinogenesis whose symptoms and tumor count improved after substitution with posaconazole.

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Figure 1.
Improvement of Voriconazole-Associated Phototoxic Effects Following Posaconazole Substitution

A, A woman in her 70s taking voriconazole for more than 5 years presented with phototoxic effects and severe actinic damage. B, One year after switching treatment to posaconazole, both phototoxic effects and tumor count decreased.

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Figure 2.
Change of Cancerous and Precancerous Lesions Following Posaconazole Substitution

A monthly lesion count is shown. The arrow indicates the date of posaconazole substitution for voriconazole, which also is the last date Mohs surgery was required.

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