Lisinopril-Induced Alopecia: A Case Report

Abstract

The American College of Cardiology Foundation/American Heart Association (ACCF/AHA) guidelines consider angiotensin-converting enzyme (ACE) inhibitors as one of the mainstay therapies in the management of heart failure. The widespread use of ACE inhibitors has been associated with several notable adverse effects such as hyperkalemia and an increased serum creatinine. There are no previous reports of alopecia associated with lisinopril use; however, a few previous cases of alopecia associated with other ACE inhibitors exist. This report discusses a case of lisinopril-induced alopecia of a 53-year-old male presenting to our outpatient heart failure clinic with a chief complaint of a new onset of alopecia. Upon evaluation, it was suspected that the patient's alopecia was likely medication induced by lisinopril; therefore, lisinopril was discontinued and switched to an angiotensin receptor blocker (ARB), losartan potassium. Alopecia resolved in 4 weeks after the therapeutic intervention. Our report suggests that the patient likely experienced a medication-induced alopecia, which was successfully resolved through proper identification and removal of the causative agent. Causality assessment between lisinopril and alopecia was determined using the Naranjo Adverse Drug Reaction Probability Scale-a total score of 6 was achieved and thus identified the adverse drug reaction as probable. Clinicians should be aware of the possibility that lisinopril may be an offending agent in a patient with unexplained alopecia.

Epidemiologic Study of Gene Distribution in Romanian and Brazilian Patients with Non-Cicatricial Alopecia

“…The immune-dependent disease known as AA is defined by the interaction of T cells with follicular antigens. Studies have revealed the presence of a local renin–angiotensin system in the skin, where the angiotensin-converting enzyme ( ACE ) is involved in autoimmunity and causes alopecia due to HF’s chronic inflammation [ 20 , 21 ]. A few cases of non-cicatricial alopecia induced by ACE inhibitors have been identified.…”

Culprits of Medication-Induced Telogen Effluvium, Part 2

“…22,23 Alopecia associated with ACE inhibitors is rare and limited to case reports following their introduction and approval in 1981. [24][25][26][27][28] In one case, a woman in her 60s with congestive heart failure initiated captopril with development of an erythematous pruritic rash on the extremities and diffuse scalp hair loss 2 months later; spontaneous hair growth resumed 1 month following captopril discontinuation. 25 In this case, the hair loss may be secondary to the drug eruption rather than true medication-induced TE.…”

Myocardial Infarction in Children after COVID-19 and Risk Factors for Thrombosis

“…During his hospital stay, the patient experienced one dermatological complication with uncertain etiology, two zones of alopecia areata (Figure 7). Alopecia areata appeared either due to stress exposure, as an adverse effect to ACE inhibitor, or triggered by coronary artery abnormalities [26][27][28][29]. We changed the lisinopril (ACE inhibitor) to losartan (angiotensin receptor blocker) and associated a local treatment according to the dermatologist's recommendation, with a favorable local evolution.…”