Losartan-induced skin reactions
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Losartan-Induced Skin Reactions: Types and Clinical Presentations
Losartan, an angiotensin II receptor antagonist commonly used for hypertension and heart failure, has been associated with a range of skin reactions. These reactions can vary from mild rashes to more severe hypersensitivity syndromes and unusual skin conditions 235.
Hypersensitivity Reactions: DRESS Syndrome
A rare but serious skin reaction linked to losartan is DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms). This condition involves skin lesions and can also affect internal organs, such as the liver. Although DRESS is more commonly associated with other medications, there are documented cases where losartan was the cause. Prompt withdrawal of losartan and initiation of systemic steroids led to a satisfactory recovery in reported cases. This highlights the importance of monitoring for skin lesions in patients taking losartan, even though it is not a typical culprit for DRESS .
Palmoplantar Hyperkeratosis and Other Cutaneous Lesions
Losartan has also been reported to cause palmoplantar hyperkeratosis, a condition characterized by thickening of the skin on the palms and soles. These lesions resolved after discontinuing losartan, suggesting a direct link. Such reactions can mimic other classical skin disorders, making it important for clinicians to consider losartan as a possible cause of sudden, unexplained skin eruptions .
Drug-Induced Rash and Lymphoid Hyperplasia
There are cases of losartan-induced rashes, which may present as simple skin eruptions. Additionally, losartan has been associated with atypical cutaneous lymphoid hyperplasia, where patients develop abnormal lymphoid cell infiltrates in the skin. These reactions can range from benign to more serious conditions that resemble lymphoma, emphasizing the need for careful evaluation of new skin findings in patients on losartan 35.
Photosensitivity Reactions
Losartan, especially when combined with hydrochlorothiazide, has been linked to drug-induced photosensitivity. This reaction involves the development of skin disorders triggered by the combination of medication and light exposure. Data from adverse event reporting systems show that losartan/hydrochlorothiazide has a high reporting odds ratio for photosensitivity, with symptoms typically appearing within two months of starting the medication. These reactions also show seasonal variation, peaking in spring months .
Mechanistic Insights: Losartan and Skin Inflammation
While losartan can cause adverse skin reactions, it also has anti-inflammatory effects in certain contexts. For example, topical losartan has been shown to reduce psoriasis-like inflammation in animal models by decreasing specific inflammatory pathways. This suggests that losartan’s effects on the skin are complex and may depend on the route of administration and individual patient factors .
Conclusion
Losartan can cause a variety of skin reactions, including DRESS syndrome, palmoplantar hyperkeratosis, rashes, atypical lymphoid hyperplasia, and photosensitivity, particularly when combined with hydrochlorothiazide. Clinicians should be aware of these potential adverse effects and consider losartan as a possible cause when patients present with new or unexplained skin symptoms. Prompt recognition and withdrawal of the drug can lead to resolution of symptoms in many cases 12356.
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