Hydrochlorothiazide use and risk of nonmelanoma skin cancer: A nationwide case-control study from Denmark

Sidsel Arnspang, David Gaist, Sigrun Alba Johannesdottir Schmidt, Lisbet Rosenkrantz Hölmich, Søren Friis, Anton Pottegård

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Background: Hydrochlorothiazide, one of the most frequently used diuretic and antihypertensive drugs in the United States and Western Europe, is photosensitizing and has previously been linked to lip cancer. Objective: To examine the association between hydrochlorothiazide use and the risk of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Methods: From the Danish Cancer Registry, we identified patients (cases) with nonmelanoma skin cancer (NMSC) during 2004-2012. Controls were matched 1:20 by age and sex. Cumulative hydrochlorothiazide use (in 1995-2012) was assessed from the Danish Prescription Registry. Using conditional logistic regression, we calculated odds ratios (ORs) for BCC and SCC associated with hydrochlorothiazide use. Results: High use of hydrochlorothiazide (≥50,000 mg) was associated with ORs of 1.29 (95% confidence interval [CI], 1.23-1.35) for BCC and 3.98 (95% CI, 3.68-4.31) for SCC. We found clear dose-response relationships between hydrochlorothiazide use and both BCC and SCC; the highest cumulative dose category (≥200,000 mg of HCTZ) had ORs of 1.54 (95% CI, 1.38-1.71) and 7.38 (95% CI, 6.32-8.60) for BCC and SCC, respectively. Use of other diuretics and antihypertensives was not associated with NMSC. Limitations: No data on sun exposure were available. Conclusions: Hydrochlorothiazide use is associated with a substantially increased risk of NMSC, especially SCC.

Original languageEnglish
JournalJournal of the American Academy of Dermatology
Issue number4
Pages (from-to)673-681.e9
Publication statusPublished - Apr 2018

Bibliographical note

Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.


  • Journal Article
  • antihypertensives
  • skin cancer
  • hydrochlorothiazide
  • pharmacology
  • cancer risk
  • nonmelanoma skin cancer
  • pharmacoepidemiology
  • Carcinoma, Basal Cell/chemically induced
  • Hydrochlorothiazide/adverse effects
  • Risk Assessment
  • Humans
  • Middle Aged
  • Male
  • Skin Neoplasms/chemically induced
  • Case-Control Studies
  • Denmark/epidemiology
  • Carcinoma, Squamous Cell/chemically induced
  • Aged, 80 and over
  • Female
  • Aged
  • Antihypertensive Agents/adverse effects


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