What is the role of hydrochlorothiazide (HCTZ) in the etiology of basal cell carcinoma (BCC)?

Updated: Mar 02, 2020
  • Author: Robert S Bader, MD; Chief Editor: William D James, MD  more...
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The widely used diuretic hydrochlorothiazide (HCTZ) is a potent photosensitizer. Slightly increased risk for BCC (and dramatically increased risk for cutaneous squamous cell carcinoma [SCC]) was documented in a case-control study that cross-referenced 71,533 cases of BCC and 8629 cases of SCC from the Danish Cancer Registry with data on cumulative HCTZ exposure in these cases with that country’s National Prescription Registry. No association was found between nonmelanoma skin cancer and other antihypertensive drugs. [41]

The study results supported a dose-response relationship between HCTZ use and BCC, as follows [41] :

  • High cumulative use of HCTZ (≥50,000 mg) increased the odds ratios (ORs) of BCC by 1.29.
  • Patients with the highest HCTZ exposure (>200,000 mg) had an OR of 1.54 for BCC.

The association of BCC with HCTZ use was strongest in younger individuals (age 50 years and younger). In these patients, the OR was 1.91. Overall, the proportion of BCCs attributable to HCTZ use was 0.6%. HCTZ showed the strongest association with skin cancers on heavily sun-exposed sites such as the lower limbs (versus the trunk). [41]

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