The People's Perspective on Medicine

Drugs That Increase Sun Sensitivity and Skin Cancer

Research has shown that certain medications (such as the diuretic HCTZ) can increase sun sensitivity and may predispose people to squamous cell skin cancer.

Are you looking forward spending some time outside during the summer. Maybe you have a beach vacation planned. Or perhaps you will be doing some walking outdoors. If you are a golfer or a tennis player, you will likely be soaking up some rays even with sunscreen. Is your medicine making you more susceptible to sunburn? A surprising number of common medications can increase sun sensitivity.

Which Medicines Boost Sun Sensitivity?

Blood Pressure Pills:

Frequenlty prescribed blood pressure medications can sensitize the skin to ultraviolet radiation from the sun. The diuretic hydrochlorothiazide or HCTZ is found in dozens of blood pressure pills. You may not even realize that your medicine contains HCTZ. Here are just a few examples:

• Atacand HCT
• Benicar HCT
• Benazepril/HCTZ
• Bisoprolol/HCTZ
• Diovan HCT
• Exforge HCT
• Lisinopril/HCTZ
• Lopressor HCT
• Losartan/HCTZ
• Lotensin HCT
• Micardis HCT
• Monopril-HCT
• Tekturna HCT
• Teveten HCT
• Triamterene/HCTZ

A study suggests that hydrochlorothiazide as well as other antihypertensive medications (lisinopril and nifedipine) may increase the risk of lip cancer (Archives of Internal Medicine, Sept. 10, 2012). This is no doubt related to the increased sun sensitivity these drugs produce.

The authors of this article note:

“Thiazide diuretics, triamterene, some ACE inhibitors and lisinopril are photosensitizing drugs. Photosensitizing drugs are believed to absorb energy from ultraviolet and/or visible light causing release of electrons. This leads to the generation of reactive oxygen intermediates and free radicals which damage DNA and other components of skin cells and produce an inflammatory response. The causation of squamous cell skin cancer by the treatment of psoriasis with repeated exposures to photosensitizing psoralen and ultraviolet radiation (PUVA) and the association of HCTZ and other antihypertensive drugs with risk of squamous cell skin cancer both support the biological plausibility of an increased risk of lip cancer due to photosensitizing antihypertensive drugs.”

Photosensitizing drugs absorb ultraviolet energy and increase the likelihood of cellular damage. Previous research has shown that such medications may predispose people to squamous cell skin cancer. People taking diuretics like hydrochlorothiazide should be especially careful to protect their skin and lips from ultraviolet sun exposure. Another popular diuretic, furosemide (Lasix), may also be linked to an increased risk of skin cancer (Journal of Investigative Dermatology, Aug., 2013).

Tetracycline:

Research from New Hampshire confirms this link,  as well as an increased risk of basal cell carcinoma, a different type of skin cancer, for people taking the antibiotic tetracycline.  The risk is highest for people who tend to burn rather than tan when exposed to sunshine.

Archives of Internal Medicine, online, Aug., 2012;   Journal of Investigative Dermatology, August 2013; Gomez-Bernal et al, Actas Dermo-sifilograficas, May 2014

Ketoprofen:

Ketoprofen is an NSAID (nonsteroidal anti-inflammatory drug) prescribed to relieve the pain of arthritis, bursitis and similar problems. Some people taking this medication end up with a rash on sun-exposed skin (Loh & Cohen, Indian Journal of Medical Research, Dec. 2016). Octocrylene, found in some sunscreens, may make this rash worse.

Report from A Readers re: Sun Sensitivity:

Jean shares this experience with HCTZ:

“Well, well. I have been ingesting HTCZ for probably 20 years. About 6 yrs ago I was diagnosed with Basal Cell cancer on the end of my nose. I had to have surgery, of course. Not a pretty site but the work was done in a doctor’s office and I went home loaded with bandages on my face and of course, discomfort.

“I was told my problem was most likely from my teen years and onward into the sun through later years. Maybe it developed from my love of sunbathing plus the HTCZ medication I still take even though my blood pressure seems to be pretty good in these later years.

“My husband is down at the pool sunning, swimming and reading and visiting at this very moment. After my experience I have lost my umph for this great relaxing way to spend some time. Never thought of this darn HTCZ being a culprit.

We both love you Graedons and have been faithful listeners to your Public Radio shows (for years now) and thank you so much for the way you help us all take care of ourselves, when possible. Keep up the good work. We need you.”

Revised 7/13/2017

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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Hello, my husband is 48 and has started taking Bystolic for over about 2 months and HCTZ was added about a month ago. Because, we have been reading that the HCTZ can cause sun sensitivity he decided to take both medications at bedtime (10pm). For the past 2 weeks he has been experiencing very vivid dreams and excruciating neck pain on the left side. He was recommended to take the HCTZ in the a.m., but it’s hard to figure when to take these meds in the TEXAS heat. I read 6pm should be the latest to take the Diuretic. He also is taking Vitamin D 50000 units 1x a week because he was deficient. He is Black and, according to the doc,he doesn’t absorb Vitamin D well.

Helen M: We all like sunshine. But it’s not necessarily good for many of us. For very fair-skinned people like me, spending 15-30 minutes/day in the sun results in red, sore, peeling skin, and the risk of skin cancer over time from cumulative sun exposure. I have a full body scanning every year by a dermatologist. During that year, I still have to see the dermatologist to have precancerous lesions ‘zapped’.

There was no sunblock when I was growing up and spending my summers outdoors. My mom used to put zinc oxide on my face and t-shirts over my bathing suit to give me at least some protection.

When I was prescribed tetracycline for an acne outbreak 35 years ago, neither the prescribing physician, a dermatologist, nor the pharmacist warned me about sun exposure. I found out on my own (no internet then) that tetracycline can indeed cause photosensitivity, resulting in an ‘exaggerated sunburn’, which I developed, along with aching joints that put me in bed three days. It took months for the redness to fade from my neck, wrists, and hands. I was wearing slacks and long sleeves when I was exposed. If I’d been sunbathing, I’d have landed in the hospital. When I told the dermatologist about it, he said “I’ve never heard of that”. I’m reminded of it daily by the healing, recently ‘zapped’ pre-cancer on my wrist.

My grandmother died of Malignant Melanoma.

I get my vitamin D from diet and supplements.

For those of you who ‘tan’ easily: A suntan is nothing more than a sunburn than looks brown. Even very dark-skinned people can get a sunburn. You don’t have to take my word for it. Check it out.

Doxycycline. Sun sensitivity is even on the patient insert.

In my case, the combination of Doxycycline and sun is the only thing that causes an HSV-1 outbreak on my lip. And it reliably does it every time.

Easier to avoid Doxycycline than sunshine, so that’s what I do.

I had to give up being in the sun to wearing long sleeves in the summer due to phototoxicity. I had allergic reactions to 2 arthritis drugs starting with hives wherever my skin was exposed to the sun for extended periods. I carry an EpiPen now since if I don’t get to a hospital fast enough the hives internalize and starts shutting down my lungs.
It is a small inconvenience to just stay out of the sun since I take other RX’s that could become drug toxic to me. This started after becoming allergic to sunscreen that had PABA in it. It is best if everyone uses PABA free sunscreen and limits exposure time in the sun.

I have taken estrogen for years (I and my gynecologist are trying to wean me off.) The insert warns that exposure to sun should be avoided. I haven’t avoided sun as I feel I need the vitamin D. I have asked MD’s about what is the harm and how does it manifest and no one knows the answer. Ellie
People’s Pharmacy response: Estrogen can sometimes cause a darkening of the skin across the cheeks in the center of the face. This side effect is called melasma and seems to be more worrisome for young women on contraceptives or pregnant women.

Well, well. I have been ingesting HTCZ for probably 20 years and about 6 yrs ago had developed Basil Cell cancer on the end of my nose. Had to have surgery, of course. Not a pretty site but the work was done in a doctor’s office and I went home loaded with bandages on my face and of course, discomfort.
Also, I was told my problem was most likely from my teen years and onward into the sun through later years, also. Maybe it developed from my love of sunbathing plus the HTCZ medication I still take even though my blood pressure seems to be pretty good in these later years.
My husband is down at the pool sunning, swimming and reading and visiting at this very moment but after my experience I have lost my umph for this great relaxing way to spend some time. Never thought of this darn HTCZ being a culprit.
We both love you Graedons and have been faithful listeners to your Public Radio shows (for years now) and thank you so much for the way you help us all take care of ourselves, when possible. Keep up the good work. We need you. Jean

St. John’s wort is nasty this way, too. One of the side effects that “natural” products aren’t supposed to have.

Agreed, Karen – St John’s Wort has left me highly photo-sensitive, even on ‘low’ sunshine days…

SA, have you thought about a long slow weaning period? If you hate it, perhaps devoting a year to getting off might help. However, you will need to find other methods of controlling your blood pressure. There is information on that here and all over the net.
I have been taking HCTZ for over 30 years, maybe even 40. It is a good thing that I tan easily, have only burned once, mildly. My husband turned into a lobster who required a doctor’s treatment for sun poisoning. It was a cloudy day, over 50 years ago, when we vacationed at Virginia Beach. Beautiful white sands that reflected that cloudy light. I finally persuaded him to go inside; alas too late. The next day he could not even get his shoes on and we had to go home. He was not taking any medication at the time, had always tanned before in the sun, his first and last burn.
Sunshine is good for us, if we treat it with the proper respect. A 15 to 30 minute exposure is all that is needed for good vitamin D production. It does not have to be done all at once. But using sun blockers will prevent the sun’s good effects.

I have been taking atenolol for 15 years.
I hate it. Have tried to come off it several times but the side effects re so severe I go back on it.
However I have had two squamous cell carcinoma s cut out. One on my chest and one on my face.
Never gave it a thought it could possibly be this medication.
Makes me hate it even more now.

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