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RF - Thiazide Diuretics and Nonmelanoma Skin Cancer
FR- Tiazidas y cáncer cutáneo no melanoma
a Servicio de Dermatología Clínica, Dermatológica Internacional, Madrid, Spain
b Servicio de Dermatología, Hospital Universitario La Princesa, Madrid, Spain
c Centro de Estudios sobre la Seguridad de los Medicamentos (CESME), Valladolid, Spain
d Centro de Farmacovigilancia de Castilla y León, Universidad de Valladolid, Valladolid, Spain
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A, Basal cell carcinoma on the upper lip. B, Definition of the tumor with a margin to be excised using Mohs surgery and adaptation of the defect so that it reaches the nasolabial fold and the line where the skin of the upper lip meets the vermillion border. C, Final defect after removal with free borders and excision of the upper and lower healthy skin. Design of the flap following the nasolabial fold and the line where the skin of the upper lip meets the vermillion border, with both lines finishing at the angle of the natural wrinkles in the oral commissure. D and E, Sutured flap with simple stitches (silk 6/0). The upper and lower scars are hidden in natural lines and the medial scar is vertical, parallel to the wrinkles. F, Appearance at removal of the stitches 7 days after surgery. <span class="elsevierStyleItalic">Case 6</span>. G, Basal cell carcinoma on the right upper lip. H, Image of the flap, which, after being worked in the subcutaneous plane by maintaining a central subcutaneous pedicle that guarantees the blood supply, advances toward the defect. The lesion had previously been removed using Mohs surgery. I, Outcome 6 months after the procedure.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Tomás-Velázquez, P. Redondo" "autores" => array:2 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Tomás-Velázquez" ] 1 => array:2 [ "nombre" => "P." 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"apellidos" => "Martin-Arias" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología Clínica, Dermatológica Internacional, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario La Princesa, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Centro de Estudios sobre la Seguridad de los Medicamentos (CESME), Valladolid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Centro de Farmacovigilancia de Castilla y León, Universidad de Valladolid, Valladolid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "FR- Tiazidas y cáncer cutáneo no melanoma" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The incidence of basal cell carcinoma in Spain is estimated at 253.23 (95% CI, 273.01−269.45) per 100 000 per year, and the incidence of cutaneous squamous cell carcinoma is 38.16 (95% CI, 31.72–39.97) per 100 000 per year.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Thiazides are widely used diuretics in Spain and, according to the summary of product characteristics, are approved for arterial hypertension, diabetes insipidus, idiopathic hypercalciuria, and edema associated with heart, kidney, or liver failure.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The Spanish Agency of Medicines and Medical Devices (Agencia Española del Medicamento y Productos Sanitarios [AEMPS]) recently provided recommendations based on a report by the Pharmacovigilance Risk Assessment Committee. The report evaluated the risks of hydrochlorothiazide (the most widely used thiazide), after the publication of 2 epidemiological studies in Denmark based on data from national databases. The studies showed the association between administration of this diuretic and increased risk of nonmelanoma skin cancer.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a> Patients exposed to hydrochlorothiazide at a cumulative dose of 50 000<span class="elsevierStyleHsp" style=""></span>mg or more were at a 1.3-fold higher risk of basal cell carcinoma and a 3.9-fold higher risk of cutaneous squamous cell carcinoma than the reference population (persons not exposed or exposed to lower doses). This risk increased to 1.54-fold and 7.38-fold in patients with cumulative doses greater than 200 000<span class="elsevierStyleHsp" style=""></span>mg.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a> The findings reported are relevant, given that treatment of hypertension, which is the main indication for hydrochlorothiazide in these patients, is usually continuous and is maintained over many years, thus increasing the possibility of reaching the cumulative dose of the medication that has been associated with a greater risk.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">It has been proposed that the most likely biological mechanism for this increased risk would be the photosensitizing activity of the thiazides, which would increase the possibility of actinic damage. It is noteworthy that no increased risk of melanoma was observed.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Based on the recommendations of the AEMPS, it seems relevant to identify patients who require treatment with hydrochlorothiazide owing to their risk of developing nonmelanoma skin cancer and thus to suggest the need for alternative options and provide information on suitable sun protection measures. Similarly, it would be important to identify and report new cases of nonmelanoma skin cancer that may be associated with the use of hydrochlorothiazide.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1332882" "palabras" => array:3 [ 0 => "Nonmelanoma skin cancer" 1 => "Thiazide diuretics" 2 => "Hydrochlorothiazide" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Rodríguez-Jiménez P, Lecaros-Astorga D, Martin-Arias LH FR- Tiazidas y cáncer cutáneo no melanoma. Actas Dermosifiliogr. 2021;112:176–177.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidencia y mortalidad del cáncer cutáneo en España: revisión sistemática y metaanálisis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Tejera-Vaquerizo" 1 => "M.A. Descalzo-Gallego" 2 => "M.M. Otero-Rivas" 3 => "Posada-García C. MM" 4 => "L. Rodríguez-Pazos" 5 => "I. 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Kim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s40264-016-0487-9" "Revista" => array:6 [ "tituloSerie" => "Drug Saf" "fecha" => "2017" "volumen" => "40" "paginaInicial" => "249" "paginaFinal" => "255" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27943160" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000011200000002/v1_202102100758/S1578219020303942/v1_202102100758/en/main.assets" "Apartado" => array:4 [ "identificador" => "34945" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Resident's Forum" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000011200000002/v1_202102100758/S1578219020303942/v1_202102100758/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219020303942?idApp=UINPBA000044" ]
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