Worsening of Rosacea in Patients Treated with Dihydropyridine Calcium Channel Blockers: a Clinical Observation

CORRESPONDENCE

Worsening of rosacea in patients treated with dihydropyridine calcium channel blockers: a clinical observation

Hypertension Research (2011) 34, 790–791; doi:10.1038/hr.2011.32; published online 31 March 2011

A 45-year-old woman made an outpatient Dihydropyridine CCBs are powerful vaso- previously taken CCBs. When patients with visit to our hypertension clinic. The woman dilators, and flushing is a common adverse rosacea discontinued the use of CCBs, there was diagnosed with essential hypertension, effect of treatment with CCBs. Thus, the use was a slow but consistent reduction of symp- and she had an average blood pressure of of CCBs may favor the appearance of sub- toms. 150/90 mm Hg, a heart rate of 70 bpm and a clinical rosacea and/or exacerbate pre-existing In all current clinical guidelines, CCBs body mass index of 26 kg mÀ2. The patient rosacea, as vasodilation stimuli can trigger belong to the class of recommended first- was not receiving any treatment at the time. this skin disorder. line antihypertensive drugs for the treatment In her medical history, there was a previous A retrospective analysis was designed to of essential hypertension. One of the main diagnosis of rosacea, and blushing was investigate the possible association between clinical side effects of CCB use is flushing, observed. She reported irregular menses CCBs and rosacea. which is experienced by B5% of patients. over the past year, with her last menses B2 The last 100 essential hypertensive patients These types of side effects, which are drug- months before the visit. who discontinued treatment with CCBs and dose-related, have a greater incidence in She was prescribed amlodipine (5 mg) and because of adverse effects were selected from women than in men (4.5 versus 1.5%, respec- instructed to check her blood pressure three our outpatient database. tively). One of the most frequent and difficult times a week for the next month. After 2 The selected patients included 54 women problems arising during antihypertensive weeks, the patient returned to the clinic and 46 men, ranging from 35 to 72 years old. therapy is lack of compliance, caused by the because of worsening skin flushing. The These patients were affected by essential life-long treatment duration and mildness of patient reported neither lifestyle changes nor hypertension and began treatment with symptoms.2 Possible causes of non-compli- the use of any other drugs or cosmetics. She CCBs for the first time before interrupting ance with antihypertensive drug regimens reported that the ‘redness’ on her cheeks treatment because of adverse side effects. include adverse side effects. Many studies worsened after a few days and that, after a The side effects reported are listed in have shown that non-compliance is a cause week, she started to notice an increased Table 1. of failure of medical therapy and of disease number of telangiectasias. Treatment with Patients who presented with flushing were progression. Strategies to improve compli- amlodipine was discontinued, and the patient referred to a dermatologist. Of the 62 patients ance with medication intake include appro- was prescribed ramipril (5 mg). After 2 addi- who discontinued therapy because of flush- priate drug selection based on patient tional weeks, skin flushing was reduced from ing, 34 were diagnosed with rosacea or pre- characteristics.3 Rosacea is not listed as a constant to occasional, and there was a con- rosacea. Rosacea was diagnosed in 34 contraindication in the Summaries of Pro- sistent decrease in the appearance of telan- patients, 23 women and 13 men, who were duct Characteristics of common clinically giectasias. This case suggests a possible between 43 and 57 years of age. These relevant CCBs. Physicians should be aware association between treatment with calcium patients were diagnosed with hypertension that subclinical rosacea could be the cause of channel blockers (CCBs) and the exacerba- within the last 3 to 5 years and had not treatment discontinuation or of the lack of tion of rosacea. Rosacea is a common skin disease with a prevalence of 0.5–10%. The disease typically Table 1 Adverse side effects that forced the interruption of the treatment with CCBs manifests with erythematous flushing, blushing, telangiectasias, papules and pustules in Side effects the central third of the face. Rosacea is Women Men Total frequently undiagnosed because the patient may be unaware of these symptoms before Flushing 13 10 23 diagnosis, but a variety of triggers or factors, Peripheral edema 12 15 27 such as vasodilators, can induce or exacerbate Flushing and edema 20 19 39 rosacea.1 Tachycardia 6 5 11 Correspondence 791 compliance with antihypertensive therapy. Alessandro Siciliano, Maria Credendino, When possible, it may be useful to choose Luigi Aronne, Paolo Calabro`, Maria 1 Culp B, Scheinfeld N. Rosacea: a Review. PT2009; 34: 38–45. another first-line antihypertensive drug G Russo and Raffaele Calabro` 2 Rudd P. Clinicians and patients with hypertension: instead of CCBs. unsettled issues about compliance. Am Heart J 1995; Second University of Naples, Monaldi 130: 572–579. 3 Benson J, Britten N. Patients’ decisions about whether or Francesco Natale, Chiara Cirillo, Hospital, Naples, Italy not to take antihypertensive drugs: qualitative study. Chiara Granato, Claudia Concilio, E-mail: [email protected] BMJ 2002; 325:873–877.

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