NSAIDs account for approximately 10 percent of cutaneous drug reactions.11 Agents most frequently involved in dermatologic complications include phenylbutazone, piroxicam, and benoxaprofen.12 Drug reactions to NSAIDs range from benign maculopapular rashes to the severe Stevens-Johnson syndrome and toxic epidermal necrolysis. NSAIDs are some of the most often-implicated drugs in cases of toxic epidermal necrolysis, accounting for up to one-third of drug-related cases in one series.13 NSAIDs of all types (oral and topical) can cause photosensitivity reactions, including increased sensitivity to sun exposure (phototoxic) and true photoallergic reactions. Piroxicam and ketoprofen are the NSAIDs most frequently involved in photoallergic reactions. One NSAID of the oxicam family, isoxicam, was removed from the US market after fatal skin reactions.
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