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Stevens-Johnson syndrome in two children in Ghana following anti-malarial treatment

ular rash that does not spare photoprotected areas. Ultraviolet-related cutaneous side effects include photosensitivity and photoallergy. Ultraviolet A rays are mainly involved in photoallergy. Antimalarial drugs with structural homologies to quinine, such as chloroquine, Mefloquine R, quinacrine, amodiaquine, quinidine and primaquine, are known to generate phototoxic products upon irradiation. Photosensitivity usually manifests itself as a marked sunburn, whereas photoallergy manifests itself either as solar urticaria (unreported for quinine), or as an exematiform rash on the photoexposed areas, which on prolonged exposure may progress to lichenification and ultimately chronic actinic dermatitis. Photosensitivity may persist up to three years after the interruption of quinine. Sensitization to quinine can be both systemic (quinine is present in sweat) and topical. Crossreactivity between quinine and quinidine photoallergy has been reported, but not with chloroquine. However, in this case, we presumed that the previous reaction to chloroquine was a photoallergy, and that there was crossreactivity with quinine. Given the limited facilities in this area, the diagnosis could not be confirmed by photopatch tests. The patient was advised to wear long sleeves and a hat and to avoid direct sun exposure, and she was given topical steroids and sun block. She was advised to mention that she was allergic to quinine, and her personal medical records clearly indicate that in the event of any future malaria attack she should be given artemisin derivatives instead of quinine –even for P. vivax infection.