Doxycycline photosensitivity

Hi,

I am heading off (for the first time) to Africa, more specifically Malawi in three weeks. I have never been anywhere requiring vaccinations and malaria medication before and am struggling to decide on the Malaria drug to choose. As with most people I have been given the options of Larium, Malarone and Doxycycline. I have done a lot of reading about the pros and cons of each drug. The manager of my project recommended avoiding Larium based on the mental side effects (although reading the posts on here it doesn't sound so bad?) which leaves Doxy and Malarone. The MASSIVE price difference and unexpected costs of all the other vaccinations lead me towards Doxy as it is so much cheaper but I am very concerned about the matter of increased photosensitivity. I am a fair red head and prone to burning in general. I have also occassionally had heat rashes in the past just on european holidays. My question to those of you who have used doxy is how severe are the reactions and how common it is? I understand that everyone reacts differently but it is difficult to tell from official "side effects" lists how serious a problem it might be. Appreciate any advise. Thanks!!

Whatever you take needs to be an individual informed choice based on proper medical advice.

For what it is worth, which is practically nothing, I have fair skin, use doxy and cover up and have never had any problems.

I've met a few people while on holiday in Thailand who have experienced photosensitivity from taking Doxy. When it happens, it can be severe, even causing the skin to blister.

I don't know how common it is, though, as a percentage value.
I've also met a couple that experienced adverse gastro reactions. Stopped when they stopped taking the Doxy.

I'd be inclined to try it, and limit sun exposure, and have a plan B if you need it.

I much prefer Doxycycline mainly because it helps to prevent traveller's tummy. I guarantee that if I use Malarone I'll get struck down. My husband was an expedition leader for many years and he says you could always tell who was on Malarone and who was on Doxycycline.
We often accompany groups and I've never seen any problems with photo sensitivity. (I'm also very fair-skinned). I have seen problems with both types when people take them on an empty stomach or just before bed. If you take them in the morning with breakfast you should be fine.

From Travelers' Malaria by Patricia Schlagenhauf-Lawlor (accessed via Google Books): "The reported rate of photosensitivity varies from ~4 to 16% or more of users, and the reaction is mild in the majority of cases..." OTOH, the same page also notes that some doxy users get Stevens-Johnson syndrome, which can be fatal.

YMMV. Cover up, wear sunscreen, and reapply it frequently.

The most reliable study I've looked at said that about 3% of users found the photosensitivity so serious that they had to stop using it. Another study, unrelated to malaria, said that about 30% of users had problems, but the study did not say how severe it was. Based on what I've seen anecdotally, I'd say that 30% sounds about right.

I've only seen a couple of reports here of people who found the sun sensitivity so bad they had to quit. Most coped with extra sunscreen, hats, long sleeves, etc. It's one thing if you are planning a jungle trek; another if it is a beach holiday.

I've seen more reports of people who had to stop taking it due to heartburn & upset stomach issues.

the same page also notes that some doxy users get Stevens-Johnson syndrome, which can be fatal.

That is associated with doxy that is seriously deteriorated, either due to age or to improper storage.

I much prefer Doxycycline mainly because it helps to prevent traveller's tummy.

Many of the bacteria that can cause travelers diarrhea have developed resistance to doxycycline, so this protection can't be guaranteed. The same source cited by #4 says
>When doxycycline was first used as a chemoprophylactic against malaria, it was speculated that it might also provide protection against travelers' diarrheas. However, doxycycline used as a malaria chemoprophylactic has not been shown to decrease travelers' diarrhea. This is likely due to the presence of widespread tetracylcine-ressitant enteric pathogens, such as enterotoxigenic Escherichia coli.

That's really useful nutrax......and really depressing news about bacteria developing resistance.......

My sister is a very pale redhead and her experience with Doxy was bad enough (blistering) that she had to stop taking it. She's taken Malarone and been fine with it.

I'm not a redhead but I'm as pale as her and tend to have a lot of reactions to medications. I took Lariam for time spent in Cambodia and India (for a total of roughly 4 months including the time before and after that you have to keep taking it) on a year-long RTW and my husband and then 7-year-old daughter took it as well.

None of us experienced any reactions and when we talked to our travel doctor (who travels a lot but extensively in Africa), he said his experience with medical residents working there was that the ones who drank were the ones who had issues. My husband chose not to drink while we were taking the Lariam and I don't drink at all, so for us it wasn't an issue. Friends we met on our trip abstained on the day they took the Lariam.

Our doctor actually had us take 2 weeks of Lariam (2 pills) at home before prescribing us more to see if we had any symptoms arise. We might still have, but it certainly made us feel more confident.

My bil had issues with larium but continued taking it for the duration of his holiday. I wouldn't have done that.

I prefer doxy have never had any side effects and in six months travel in india when i drink water from restaurant jugs not bottled water and break most of the water and food rules, i didn't really suffer from any tummy uspets. I don't know whether its due to the doxy, to my hardened stomach/greater resistance or to their being no bugs in the water. probably all three i think. I didn't take doxy for the whole six months. Probably only about two.

Perhaps the people who get sunbrutn while taking doxy use crummy sunblock and don't put it on very often so of course they get sunburnt.

Sunblock take it from home, buy a respected brand not a cosmetic brand. It should include zinc oxide. Apply half an hour before going in the sun and reapply every two hours. That's how you are supposed to use it. Also you need 1 tsp for your face. 1 tsp for each arm. add more for your neck area.

Wear a hat whenever you are outside or carry an umbrella.

For prickly heat rashes have some bicarb soda and make a thick paste and apply it to the rash. Do not allow yourself to get too sweaty as this is what causes prickly heat.

So because it cheaper and if you that's why you would prefer it, then try out the doxy before you leave home to see how you handle it. Of course you may not be able to notice any photosensitivity if you live in a place like uk.

I've worked for a NGO sending volunteers to Malawi, Uganda, Tanzania and Kenya and out of 500+ volunteers have never heard of anyone being affected by this.

I'm now working for an NGO in Madagascar, again with hundreds of volunteers, and for whatever reason about 50% of people on doxy get affected. In about 10% of cases (where they don't cover up/get out of the sun in time) it results in extremely bad burns and eventually fingernails drop off. Pretty much all those people have taken doxy in other countries and never had a problem, so we think there's just something strange about Madagascar!

This isn't based on any kind of fact, just personal observation. Make sure you have clothes to cover up, plenty of suncream and a hat, and doxy should be fine, I think.

saint aelphhaba you dont' think there's a possibiliyt that its a question of awareness and perhaps false attribution.

I mean if no one in malawi has a problem and a lot of people in madagascar have a problem so its probalby got nothing to do with doxy at all.

Especially since the problem is in other people who use doxy in other countries. so yeah i now suspect this photosensitivity has nothing to do with doxy after all.

The thing is if people don't cover up they do get badly sunburnt. That's just the sun not the doxy. From years of living and sunbaking i know how easily it is to get brutn and for people who do not come from a tropical climate, they simply are more sensitive and more ignorant about how easy it is to get badly burnt. You simply can't say that extreme sunburn is due to doxy when you have these other issues unless you notice that people not taking doxy are not ever showing up with the same problems. Which i doubt.

the fingernails dropping off sounds like something else altogether. A fungal disease most likely.

Argue all you want, #10, but photosensitivity is an established side effect of doxycycline in a percentage of cases. You can't change that.

The question at hand is, "what percentage?" Nutrax has, as usual, offered a good answer.

As for fingernails falling off, this is the first I've heard of it too. I'll reserve judgment.

Mark

"there's just something strange about Madagascar"

There are many strange things about Madagascar. I wonder what was going on. Perhaps an environmental factor that made people more sensitive to the sun, different behaviour from the people i.e. staying out in the sun longer, or perhaps, in view of the fingernails falling off, another cause entirely.

and agree with Nutrax and mark about sun sensitivity and doxy.

#10-#12, your new word of the day is "photo-onycholysis" (or "photoonycholysis"). I'll leave it to you to find out how it is relevant in this thread.

Thank you that is most interesting and nice images too.

I Just know this is going to be about fingernails falling.

Edited by: NewIslander

I'm going to africa as well this summer, and am thinking of going with doxy as Malarone will set me back £200 as opposed to £20 for doxy (I'm going for 9 weeks). Do you reckon that it's most likely fair skinned people who are more likely to get the problem of photosensitivity? I'm someone with light olive-toned skin and it's extremely rare for me to burn despite usually not wearing suncream. Since I don't usually wear suncream, I'm thinking if I go with the doxy, I'll take an SPF 15 and an SPF30 with me and see how that goes?

Do you mean its extrememly rare for you to get sunburned when you are in england? Go with doxy. and just use sunscreen and wear a hat. I'm quite fair but i do tan up quite well too even when wearing sunscreen but being out all day in the sun. ie if you are out in the sun all day you will definitely get a tan if wear sunblock and even applying it frequently. and you will definitely get sunburnt if you do not cover up or apply sunblock regularly regardless of doxy, so covering up is the only way to really protect yourself when in the strong sun.

no it's extremely rare for me to burn ever (i've travelled quite a lot to hot, tropical places and get away with a factor 4 suncream). if i ever do burn (which has probably amounted to maybe 5 times in my life), it's only ever on the shoulders and goes brown a few hours later. i've never been sunburned in england and i don't wear sunblock here so i think i'll just take the SPF 15/30 with me, and see how it goes.

Edited by: jessica90

Edited by: jessica90

even black people can get sunburnt. Even if you don't burn, you will get tanned and suffer skin damage ultimately that's why you should wear sunblock. No one is immune to sun damage. By sun damage i dno't mean just risk skin cancer, i mean wrinkles. It is sun that causes wrinkles apart from usual aging and loss of elasticity due to age.