Christensen Gustav Boelsgaard, Kappelin Johan, Sandgren Jenny, Nielsen Kari, Ingvar Åsa
Department of Dermatology, Skåne University Hospital, Lund, Sweden.
Lund University Skin Cancer Research Group, Dermatology, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden.
Photodermatol Photoimmunol Photomed. 2025 Mar;41(2):e70013. doi: 10.1111/phpp.70013.
Several widely used drugs have photosensitizing properties, and much research has been conducted to find associations between their use and the risk of developing cutaneous malignant melanoma (cM), basal cell carcinoma (BCC) or cutaneous squamous cell carcinoma (cSCC), often with conflicting results.
To assess whether the use of commonly prescribed photosensitizing drugs increases skin cancer risk.
Analyses were performed using a large cohort of women, with prospectively collected information on phenotypic traits and sun exposure. Comprehensive information on pharmaceutical treatments and skin cancer occurrence was obtained through national registries. Drugs with photosensitizing properties were grouped according to the Anatomical Therapeutic Chemical system in nine groups, and associations between the use of such drugs were investigated using multivariable Cox regression analysis. The number of retrieved daily doses was analyzed to test the dose-response relationship.
Hormone replacement therapy significantly increased the risk of BCC (hazard ratio [HR] 1.24; 95% confidence interval [CI]: 1.11-1.39), cSCC (HR 1.23; 95% CI: 1.03-1.47) and cM (HR 1.31; 95% CI: 1.01-1.69), with estrogen driving this risk. There was a trend of increased risk of BCC and cM with higher doses of estrogen treatment. Subgroup analysis among those using diuretics showed that loop diuretics were associated with increased cSCC risk (HR 1.6; 95% CI: 1.3-2.0), including a positive association between risk and dose. Furthermore, increased risks of BCC (HR 1.25; 95% CI: 1.09-1.44) and cM (HR 1.41; 95% CI: 1.03-1.93) were associated with thiazide use. NSAIDs showed a possible curvilinear association to BCC and cSCC.
Estrogen treatment increased the risk of all investigated skin cancers. Among those using diuretics, loop diuretics increased the risk of cSCC, and thiazide use increased the risk of BCC. We suggest that physicians should advise female patients prescribed estrogen, thiazides, or loop diuretics to limit their sun exposure.
几种广泛使用的药物具有光敏特性，人们进行了大量研究以探寻这些药物的使用与发生皮肤恶性黑色素瘤（cM）、基底细胞癌（BCC）或皮肤鳞状细胞癌（cSCC）风险之间的关联，结果往往相互矛盾。
评估常用的光敏药物使用是否会增加皮肤癌风险。
对一大群女性进行分析，前瞻性收集了有关表型特征和日晒情况的信息。通过国家登记处获得了有关药物治疗和皮肤癌发生的全面信息。具有光敏特性的药物根据解剖治疗化学系统分为九组，并使用多变量Cox回归分析研究此类药物使用之间的关联。分析检索到的每日剂量数量以检验剂量反应关系。
激素替代疗法显著增加了BCC（风险比[HR]1.24；95%置信区间[CI]：1.11 - 1.39）、cSCC（HR 1.23；95% CI：1.03 - 1.47）和cM（HR 1.31；95% CI：1.01 - 1.69）的风险，雌激素是导致这种风险的原因。随着雌激素治疗剂量的增加，BCC和cM的风险有增加趋势。在使用利尿剂的人群中进行的亚组分析表明，袢利尿剂与cSCC风险增加相关（HR 1.6；95% CI：1.3 - 2.0），包括风险与剂量之间呈正相关。此外，噻嗪类药物的使用与BCC（HR 1.25；95% CI：1.09 - 1.44）和cM（HR 1.41；95% CI：1.03 - 1.93）风险增加相关。非甾体抗炎药与BCC和cSCC之间显示出可能的曲线关联。
雌激素治疗增加了所有调查的皮肤癌风险。在使用利尿剂的人群中，袢利尿剂增加了cSCC的风险，噻嗪类药物的使用增加了BCC的风险。我们建议医生应建议开了雌激素、噻嗪类药物或袢利尿剂的女性患者限制日晒。
