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The use of doxycycline is increasing. A mainstay of initial treatment for community-acquired pneumonia, it is also a preferred drug for treatment of tick-borne conditions such as Lyme disease and ehrlichiosis. Photosensitivity is a well-known adverse reaction to tetracyclines; avoidance of sun exposure and use of sunblock often are recommended during therapy.
Investigators at the Netherlands Pharmacovigilance Centre Lareb recently described five cases of onycholysis in patients receiving only minimal doses (200 mg/day for 1-4 weeks) of doxycycline as Lyme prophylaxis. Sun exposure was documented in all five cases, and no other potentially responsible agent or condition could be identified. Time from beginning of therapy to onset of onycholys…