Photoinduced skin reactions of cardiovascular drugs—a systematic review

Abstract

Purpose This systemic review aims to provide a practical overview of the prevalence, clinical manifestation, and management of adverse photo-induced skin reactions caused by frequently used cardiovascular drugs and to assess their potential relevance for skin cancer development. Methods Data search included PubMed, Web of Science, and the Cochrane Library. A systematic review of peer-reviewed studies reporting the photosensitizing and/or skin cancer-inducing properties of common cardiovascular drugs was performed and a guide to clinical management of photo-induced skin eruptions by cardiovascular drugs was provided. Study quality was assessed for major methodological biases. Results A total of 58 studies were identified (i.e. 23 case reports, 14 observational studies, 10 review articles, 10 experimental studies, and 1 meta-analysis). Most commonly, drug-associated adverse photo-induced cutaneous reactions were caused by phototoxic and photoallergic mechanisms. There is evidence suggesting that amiodarone and dronedarone, thiazide-diuretics, thiazide-like-diuretics, angiotensin receptor blockers, dihydropyridine-type calcium channel blockers as well as certain ACE-inhibitors and statins may cause photo-induced adverse cutaneous reactions. Other drugs such as anticoagulants, antiplatelets, aldosterone antagonists, and fibrates have not been linked with photosensitizing reactions or adverse cutaneous reactions. Some drugs, i.e. thiazides and thiazide-like-diuretics, were associated with an increased risk of non-melanoma skin cancers (basal cell carcinoma, squamous cell carcinoma). Conclusions Certain commonly used cardiovascular drugs have been associated with adverse photo-induced cutaneous reactions. If they occur, further diagnosis and treatment might be needed, depending on the severity and progress. Whether photosensitizing drugs increase the risk of skin cancer remains elusive and further randomized, controlled trials are required.

Exposome and basal cell carcinoma: a multicenter case–control study

“…24,25 Thiazides and ACE inhibitors have been associated with an increased risk of NMSC. 26,27 In agreement with our findings, previous studies have suggested that tumor risk may be increased by antihypertensive drugs, particularly hydrochlorothiazide, owing to its photosensitizing properties. 28 Finally, while no studies showed evidence of an association between omeprazole use and BCC risk, omeprazole is included among the photosensitizing drugs which could explain this relationship.…”

A randomized, placebo-controlled, trial to assess the photosensitizing, phototoxic and carcinogenic potential of hydrochlorothiazide in healthy volunteers

“…Several case reports describe phototoxic reactions in HCT treated patients [24]. It is important to emphasize, however, that these adverse cutaneous reactions can occur following almost any drug therapies, apart from HCT [1]. Therefore, phototoxic reactions to HCT appear to be individual reactions (possibly by photoallergy) and the majority of individuals treated with HCT do not experience adverse side effects.…”

“…The thiazide-diuretic hydrochlorothiazide (HCT) is commonly used in the management of hypertension and heart failure [2][3][4]. Ever since its introduction in the 1950 s, HCT has been suspected to increase photosensitivity, leading to adverse cutaneous reactions in susceptible individuals [1,5]. Recently, pharmacoepidemiologic case-control studies associated the longterm use of HCT with increased rates of skin cancer, such as basal cell carcinoma and squamous cell carcinoma [6][7][8][9].…”

“…V arious drugs increase skin photosensitivity thereby causing skin damage and possibly skin cancer, mainly by alteration of the pernicious effects of ultraviolet radiation (UVR) [1]. The thiazide-diuretic hydrochlorothiazide (HCT) is commonly used in the management of hypertension and heart failure [2][3][4].…”

The phenomenon of phototoxicity and long-term risks of commonly prescribed and structurally diverse drugs

“…Amiodarone is a class III antiarrhythmic drug used in cardiovascular diseases such as supraventricular and ventricular arrhythmias [ 98 , 143 ]. Some studies have suggested that phototoxic reactions affect up to 75 % of patients on long-term amiodarone therapy [ 144 , 145 ], while one recent prospective study in a French population reported an incidence rate of less than 10 % [ 112 ].…”