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Photosensitizing Drugs and Risk of Skin Cancer in Women-A Prospective Population-Based Study
Gustav Boelsgaard Christensen1,2, Johan Kappelin2,3, Jenny Sandgren4
1Department of Dermatology, Skåne University Hospital, Lund, Sweden.
Photodermatology, Photoimmunology & Photomedicine
|March 18, 2025
Summary
Commonly prescribed photosensitizing drugs like estrogen, loop diuretics, and thiazides are linked to increased skin cancer risk. Physicians should advise patients using these medications to limit sun exposure to mitigate risks of basal cell carcinoma, squamous cell carcinoma, and malignant melanoma.
Area of Science:
- Dermatology and Oncology
- Pharmacology and Therapeutics
Background:
- Several common medications possess photosensitizing properties, leading to research on their association with skin cancer.
- Previous studies on photosensitizing drugs and skin cancer risk (cutaneous malignant melanoma, basal cell carcinoma, cutaneous squamous cell carcinoma) have yielded conflicting results.
Purpose of the Study:
- To investigate the association between the use of commonly prescribed photosensitizing drugs and the risk of developing skin cancer.
- To assess if specific drug classes increase the risk of basal cell carcinoma, cutaneous squamous cell carcinoma, or cutaneous malignant melanoma.
Main Methods:
- A large cohort of women with prospectively collected data on phenotypic traits and sun exposure was analyzed.
- Information on pharmaceutical treatments and skin cancer incidence was obtained from national registries.
- Drugs with photosensitizing properties were categorized using the Anatomical Therapeutic Chemical system, and their associations with skin cancer were examined using multivariable Cox regression, including dose-response analyses.
Main Results:
- Hormone replacement therapy, particularly estrogen, significantly elevated the risk of basal cell carcinoma, cutaneous squamous cell carcinoma, and cutaneous malignant melanoma.
- Loop diuretics were associated with an increased risk of cutaneous squamous cell carcinoma, with a dose-response relationship observed.
- Thiazide use was linked to increased risks of basal cell carcinoma and cutaneous malignant melanoma, while NSAIDs showed a potential curvilinear association with basal cell carcinoma and cutaneous squamous cell carcinoma.
Conclusions:
- Estrogen-containing therapies increase the risk of all studied skin cancers.
- Loop diuretics are associated with higher risks of cutaneous squamous cell carcinoma, and thiazides with increased basal cell carcinoma risk.
- Physicians should counsel patients on estrogen, thiazide, or loop diuretic use regarding sun exposure to reduce skin cancer risk.
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