Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital Saarland, Saarland University, Geb. 41, Kirrbergerstraβe 100, 66424 Homburg, Germany.
Department of Adult and Pediatric Dermatology, Venereology, Allergology, University Hospital Saarland, Saarland University, 66424 Homburg, Germany.
Eur Heart J Cardiovasc Pharmacother. 2022 Jun 8;8(4):420-430. doi: 10.1093/ehjcvp/pvac017.
This systemic review aims to provide a practical overview of the prevalence, clinical manifestation, and management of adverse photoinduced skin reactions caused by frequently used cardiovascular drugs and to assess their potential relevance for skin cancer development. 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 photoinduced skin eruptions by cardiovascular drugs was provided. Study quality was assessed for major methodological biases. 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 photoinduced 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, and certain angiotensin-converting enzyme inhibitors and statins may cause photoinduced 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 and squamous cell carcinoma). Certain commonly used cardiovascular drugs have been associated with adverse photoinduced 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.
本系统评价旨在提供一个常见心血管药物引起的光诱导皮肤不良反应的流行情况、临床表现和管理的实用概述，并评估其对皮肤癌发展的潜在相关性。数据检索包括 PubMed、Web of Science 和 Cochrane 图书馆。对报告常见心血管药物光致敏性和/或皮肤致癌性的同行评审研究进行了系统评价，并提供了心血管药物引起的光诱导皮肤疹的临床管理指南。评估了主要方法学偏倚的研究质量。共确定了 58 项研究（即 23 例病例报告、14 项观察性研究、10 篇综述文章、10 项实验研究和 1 项荟萃分析）。最常见的是，药物相关的光诱导皮肤不良反应是由光毒性和光过敏机制引起的。有证据表明，胺碘酮和决奈达隆、噻嗪类利尿剂、噻嗪样利尿剂、血管紧张素受体阻滞剂、二氢吡啶型钙通道阻滞剂以及某些血管紧张素转换酶抑制剂和他汀类药物可能引起光诱导的皮肤不良反应。其他药物，如抗凝剂、抗血小板药物、醛固酮拮抗剂和贝特类药物，与光致敏反应或皮肤不良反应无关。某些药物，如噻嗪类和噻嗪样利尿剂，与非黑色素瘤皮肤癌（基底细胞癌和鳞状细胞癌）的风险增加有关。某些常用的心血管药物与光诱导的皮肤不良反应有关。如果发生这些反应，可能需要进一步诊断和治疗，具体取决于严重程度和进展情况。光致敏药物是否会增加皮肤癌的风险仍不清楚，需要进一步的随机对照试验。
