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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present a case of mesalamine-induced photosensitivity in a patient with Ulcerative Colitis &#40;UC&#41;&#46; To the best of our knowledge&#44; this is the fourth case of mesalamine-induced photosensitivity reported so far&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In April 2018&#44; a 26-year-old male presented with diffuse erythema and erythematous papules on sun-exposed areas &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41;&#46; Skin lesions appeared during the first sunny spring days &#40;average UV index was 5 &#8210; moderate&#41;&#46; He has no previous history of sun sensitivity&#46; In personal history&#44; five weeks before admission to our department&#44; he started treatment for UC&#46; Treatment included oral and rectal forms of mesalamine alongside oral prednisolone and esomeprazole&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">At admission routine laboratory analysis of blood and urine were within normal limits&#46; Immunological analysis &#40;IgG&#44; IgM anti-cardiolipin antibodies&#44; IgG anti-mitochondrial antibodies&#44; IgG anti-nucleus antibodies&#44; IgG anti-smooth muscle antibodies&#44; IgG anti-liver kidney microsome type 1 antibodies&#44; IgG anti-parietal antibodies&#44; anti-Extractable Nuclear Antigen &#40;ENA&#41; antibody screen&#44; IgG anti-dsDNA&#44; C3 and C4&#41; were all negative&#46; HIV antigen&#47;antibody&#44; HBsAg&#44; and anti-HCV were all negative&#46; VDRL was negative&#46; Lupus bend tests from sun-exposed and sun-protected areas were negative&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">We suggested sun protection along with sun avoidance and initiated topical corticosteroid preparations with concomitant UC treatment &#40;mesalamine 3&#8239;g&#47;day&#44; prednisolone 20&#8239;mg&#47;day and esomeprazole 20&#8239;mg BID&#41; for 4 days&#46; The suggested treatment was without result&#44; erythema was persistent&#46; Due to suspicion that sun sensitivity was induced by mesalamine&#44; mesalamine and topical corticosteroid treatment were discontinued and 20&#8239;mg of prednisolone alongside esomeprazole and sun protection remain the only treatment&#46; During the following 4 days&#44; he spent up to 1&#8239;hour&#47;day in the sun and despite that&#44; there was a complete regression of skin lesions &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">We were interested on whether photosensitivity appears again in the absence of mesalamine so&#44; we suggested unlimited sun exposure without sun protection&#44; for the next 6 days &#40;10 days in total without mesalamine&#41;&#46; During those days were no signs of photosensitivity&#44; but UC worsened and mesalamine re-challenge was approached&#46; He took the first&#44; reintroduced&#44; dose of mesalamine and 12&#8210;15&#8239;h later&#44; he spent 30&#8239;minutes outside on a sunny morning&#46; During those 30&#8239;minutes&#44; erythema reappeared on sun-exposed areas&#46; We established the diagnosis of mesalamine-induced photosensitivity &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41;&#46; The gastroenterologist substituted mesalamine with azathioprine and prednisolone was tapered and stopped&#46; UC has been in remission since October 2018&#44; and as of April 2023&#44; he has no manifestations of sun sensitivity&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Mesalamine is the preferred&#44; safe&#44; first-line treatment with proven efficacy in mild to moderate forms of UC<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> with mild systemic absorption despite its delayed release mechanism&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> According to the literature mesalamine may be associated with skin rashes and pruritus&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Many drugs have been implicated in photosensitive reactions but mesalamine is not considered to be one&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a> Only one case of probable esomeprazole-induced photoallergic dermatitis has been reported so far&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Cutaneous adverse drug reactions in sun-exposed areas may be phototoxic or photo-allergic type&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Photo-toxicity appears rapidly after sun exposure because of light activation of the photosensitizing agent&#44; while photoallergy skin lesion appears after 2&#8210;3 days due to activation of cell-mediated immune response&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Esomeprazole was not in the treatment protocol in other reported cases with mesalamine-induced photosensitivity&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a> In our patient photosensitivity was not associated with esomeprazole intake&#46; The proof for that is that he had no skin lesions while being treated with esomeprazole in periods when mesalamine was temporarily or permanently withdrawn&#46; The prompt reappearance of erythema in our patient after mesalamine re-challenge indicates a phototoxic type of photosensitivity&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Among all published cases &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;&#41; our case is the only case with discontinuation of mesalamine treatment and a re-challenge test&#46; In accordance with the Naranjo ADR probability scale&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> the strength of association between mesalamine and the development of &#40;sun&#41; photosensitivity in our patient was &#8220;definite&#8221; &#40;total score 9&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">In reported cases&#44; the period of photosensitivity onset after mesalamine introduction ranged from 2 weeks to 6 months &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; In our patient&#44; erythema completely disappeared within 4 days after mesalamine was withdrawn similar to Al-Niaimi et al&#46; reported resolution within 10 days&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However&#44; Cozzani et al&#46; reported complete resolution 6 months after discontinuation of mesalamine&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Interestingly Horiuchi et al&#46; never withdrew mesalamine and reportedly symptoms were controlled by sun protection&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">To conclude&#44; we believe that dermatologists should be aware of photosensitivity as a possible mesalamine side effect&#44; to avoid unnecessary clinical evaluations&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Financial support</span><p id="par0055" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Author&#8217;s contributions</span><p id="par0060" class="elsevierStylePara elsevierViewall">Svetlana Popadic&#58; The study concept and design&#59; data collection&#44; or analysis and interpretation of data&#59; statistical analysis&#59; writing of the manuscript or critical review of important intellectual content&#59; data collection&#44; analysis&#44; and interpretation&#59; effective participation in the research guidance&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#59; final approval of the final version of the manuscript&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Igor Kapetanovic&#58; Writing of the manuscript or critical review of important intellectual content&#59; data collection&#44; analysis and interpretation&#59; final approval of the final version of the manuscript&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Aleksandra Sokic-Milutinovic&#58; Intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#59; final approval of the final version of the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflicts of interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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          "titulo" => "References"
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    "fechaRecibido" => "2023-04-24"
    "fechaAceptado" => "2023-07-10"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Department of Dermatovenereology School of Medicine&#44; University of Belgrade&#44; Clinic of Dermatovenereology University Clinical Center of Serbia&#44; Belgrade&#44; Serbia</p>"
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    ]
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Erythema and erythematous papules on the cheeks&#44; auricles&#44; and neck&#46; &#40;B&#41; Face&#44; auricles&#44; and neck without skin lesions&#46; &#40;C&#41; Erythema and erythematous papules on the scalp&#44; face&#44; auricles&#44; and neck&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Erythema and erythematous papules on dorsal side of the hands&#46; &#40;B&#41; Dorsal side of the hands without skin lesions&#46; &#40;C&#41; Erythema on dorsal side of the hands&#46;</p>"
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          "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">NA&#44; Not applicable &#40;mesalamine not discontinued&#41;&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patient age at presentation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Onset of symptoms after mesalamine introduction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Season at the time of onset of skin lesions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Symptom resolution after mesalamine discontinuation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mesalamine re-exposure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Our patient</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Spring&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Al-Niaimi et al&#46;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#8210;3 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Summer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Cozzani et al&#46;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Summer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Horiuchi et al&#46;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Spring&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Cases of mesalamine induced photosensitivity reported in the literature&#46;</p>"
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                    0 => array:2 [
                      "titulo" => "Mesalazine and photosensitivity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Y&#46; Horiuchi"
                            1 => "S&#46; Shimakura"
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                    0 => array:2 [
                      "doi" => "10.1111/j.1572-0241.1999.03386.x"
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                        "tituloSerie" => "Am J Gastroenterol"
                        "fecha" => "1999"
                        "volumen" => "94"
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                      "titulo" => "Photosensitivity induced by mesalazine&#58; report of a case"
                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46; Cozzani"
                            1 => "F&#46; Pappalardo"
                            2 => "R&#46; Gallo"
                            3 => "A&#46; Parodi"
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                      ]
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                  ]
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                    0 => array:2 [
                      "doi" => "10.1038/ajg.2014.79"
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                        "tituloSerie" => "Am J Gastroenterol"
                        "fecha" => "2014"
                        "volumen" => "109"
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                        0 => array:2 [
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                        "tituloSerie" => "Inflamm Bowel Dis"
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