Hydrochlorothiazide Use and Risk of Nonmelanoma Skin Cancer |

March 28, 2018

Journal of the American Academy of Dermatology

TAKE-HOME MESSAGE

This retrospective study sought to determine if hydrochlorothiazide use was linked to the development of basal cell carcinoma (BCC) or squamous cell carcinoma (SCC), the nonmelanoma skin cancers (NMSC). Researchers examined data from the Danish Cancer Registry from 2004 to 2012 and the Danish Prescription Registry from 1995 to 2012. After a conditional logistic regression, high use of hydrochlorothiazide (≥50,000 mg) was found to be significantly associated with the development of BCC and SCC (OR, 1.29 for BCC; OR, 3.98 for SCC). Moreover, a dose–response relationship was identified between use of hydrochlorothiazide and NMSC, with the highest risk for BCC and SCC in individuals with the most exposure to hydrochlorothiazide (≥200,000 mg).
In this Danish population, there was a significant risk for NMSC, especially SCC, associated with the use of hydrochlorothiazide. This risk appears to increase with greater exposure to the drug.

Abstract

BACKGROUND

Hydrochlorothiazide, one of the most frequently used diuretic and antihypertensive drugs in the United States and Western Europe, is photosensitizing and has previously been linked to lip cancer.

OBJECTIVE

To examine the association between hydrochlorothiazide use and the risk of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).

METHODS

From the Danish Cancer Registry, we identified patients (cases) with nonmelanoma skin cancer (NMSC) during 2004-2012. Controls were matched 1:20 by age and sex. Cumulative hydrochlorothiazide use (in 1995-2012) was assessed from the Danish Prescription Registry. Using conditional logistic regression, we calculated odds ratios (ORs) for BCC and SCC associated with hydrochlorothiazide use.

RESULTS

High use of hydrochlorothiazide (≥50,000 mg) was associated with ORs of 1.29 (95% confidence interval [CI], 1.23-1.35) for BCC and 3.98 (95% CI, 3.68-4.31) for SCC. We found clear dose-response relationships between hydrochlorothiazide use and both BCC and SCC; the highest cumulative dose category (≥200,000 mg of HCTZ) had ORs of 1.54 (95% CI, 1.38-1.71) and 7.38 (95% CI, 6.32-8.60) for BCC and SCC, respectively. Use of other diuretics and antihypertensives was not associated with NMSC.

LIMITATIONS

No data on sun exposure were available.

CONCLUSIONS

Hydrochlorothiazide use is associated with a substantially increased risk of NMSC, especially SCC.

Journal Abstract

Hydrochlorothiazide Use and Risk of Nonmelanoma Skin Cancer