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Stratified temporal risk of skin cancer by age associated with hydrochlorothiazide: a retrospective cohort study using the TriNetX database
Journal article   Peer reviewed

Stratified temporal risk of skin cancer by age associated with hydrochlorothiazide: a retrospective cohort study using the TriNetX database

Taylor Merkle, Celter Odango and Erum N. Ilyas
Archives of dermatological research, v 318(1), 193
04 Jun 2026
DOI: https://doi.org/10.1007/s00403-026-04633-4

Abstract

Medicine Medicine & Public Health Short Report Dermatology
Hydrochlorothiazide (HCTZ) is known to have photosensitizing properties with recent FDA labeling updates warning of its increased risk of nonmelanoma skin cancer (NMSC). There are few and at times conflicting studies in the current literature on the topic, in particular regarding melanoma associations and significant confounders. This retrospective cohort study utilizing the TriNetX database investigates age and temporal associations between the initiation of HCTZ as monotherapy for hypertension (HTN) and the diagnosis of basal cell carcinoma (BCC), cutaneous squamous cell carcinoma (cSCC), and melanoma. Six adult (age >18) cohorts were created with (1) HTN (ICD10: I10) as control and (2) HTN with HCTZ; then further stratified by age from 18 to 49 and 50 to 75. Outcomes assessed were BCC, cSCC, and melanoma at 5 and 10 years. HCTZ usage in cohorts aged 50 to 75 years old was significantly (p<0.05) associated with increased hazard ratios for BCC and cSCC at 5 and 10 years but not consistently with melanoma. This study refines prior reports of HCTZ usage associated with development of BCC and cSCC particularly in older adults while controlling for confounders such as concurrent antihypertensives, race, ethnicity, and smoking in a US based population. We highlight the need for increased dermatological surveillance and counseling among this vulnerable population, especially for those over the age of 50 on sustained HCTZ therapy.

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