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.