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. 2025 Mar;41(2):e70013.
doi: 10.1111/phpp.70013.

Photosensitizing Drugs and Risk of Skin Cancer in Women-A Prospective Population-Based Study

Gustav Boelsgaard Christensen  1   2 , Johan Kappelin  2   3 , Jenny Sandgren  4 , Kari Nielsen  1   2   5 , Åsa Ingvar  1   2
Affiliations

Photosensitizing Drugs and Risk of Skin Cancer in Women-A Prospective Population-Based Study

Gustav Boelsgaard Christensen et al. Photodermatol Photoimmunol Photomed. 2025 Mar.

Abstract

Background: 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.

Objective: To assess whether the use of commonly prescribed photosensitizing drugs increases skin cancer risk.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: basal cell carcinoma; melanoma; photosensitizing drugs; prospective; squamous cell carcinoma.

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Conflict of interest statement

G.B.C. has received speaker honoraria from LEO Pharma and UCB Pharma. K.N. has received speaker honoraria from Galderma Sweden, LEO Pharma, Novartis Sweden, and UCB Pharma and has served on one advisory board for MSD. Å.I. has received speaker and consulting honoraria from Galderma Sweden, Perrigo Sweden, MSD Sweden, and Biofrontera Sweden. J.K. has received speaker honoraria from Galderma Sweden and Sanofi Sweden. The other authors declare no conflicts of interest. The companies providing honoraria did not influence the design, data collection, analysis, interpretation, or reporting of the study.

Figures

FIGURE 1
FIGURE 1
Number of individuals divided by skin cancer type and overlap between skin cancer types, presented as the number of individuals. cM, cutaneous melanoma; BCC, basal cell carcinoma; cSCC, cutaneous squamous cell carcinoma. *Total number of persons diagnosed with a specific skin cancer type. +Number of persons diagnosed exclusively with a specific skin cancer type. §Number of persons diagnosed with two or three different skin cancer types, categorized according to specific combinations.
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References

    1. Cust A. E., Armstrong B. K., Goumas C., et al., “Sunbed Use During Adolescence and Early Adulthood Is Associated With Increased Risk of Early‐Onset Melanoma,” International Journal of Cancer 128 (2011): 2425–2435. - PMC - PubMed
    1. Christensen G. B., Ingvar C., Hartman L. W., Olsson H., and Nielsen K., “Sunbed Use Increases Cutaneous Squamous Cell Carcinoma Risk in Women: A Large‐Scale, Prospective Study in Sweden,” Acta Dermato‐Venereologica 99 (2019): 878–883. - PubMed
    1. Stanganelli I., Gandini S., Magi S., et al., “Sunbed Use Among Subjects at High Risk of Melanoma: An Italian Survey After the Ban,” British Journal of Dermatology 169 (2013): 351–357. - PubMed
    1. Armstrong B. K. and Kricker A., “The Epidemiology of UV Induced Skin Cancer,” Journal of Photochemistry and Photobiology. B, Biology 63 (2001): 8–18. - PubMed
    1. Thompson J. F., Scolyer R. A., and Kefford R. F., “Cutaneous Melanoma,” Lancet 365 (2005): 687–701. - PubMed

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