Avaliação do uso de hidroclorotiazida em pacientes com carcinoma basocelular atendidos em ambulatório de dermatologia

Abstract

Introduction: According to the National Cancer Institute (INCA), nonmelanoma skin cancer represents 30% of all malignant neoplasm in Brazil. These tumors have low lethality but high morbidity, so recognition of risk factors and early diagnosis are determinant for prognosis. Basal cell carcinoma arises from non-keratinized cells from the basal layer of the epidermis and represents 76% of all non-melanoma skin cancer (CPNM). In Brazil, approximately 165,580 new cases of this neoplasm were estimated, with tendency to increase this rate for the next years. It is locally invasive, usually nonagressive and destructive of skin, despite its low metastatic potential, being more common among the elderly, white populations and male. Its main clinical presentation is a papule ou nodule with a pearly aspect, often with typical telangectasy located mainly in the head and neck region. Some studies have related hydrochlorothiazide, one of the main antihypertensive drugs used in Brazil, as a potential risk factor for the development of Basal Cell Carcinoma (CBC). This led the National Health Surveillance Agency (ANVISA) to release a note informing about the increased risk of nonmelanoma skin cancer with the use of the drug and recommending that physicians report this risk to patients, as well to guide patients for regular self-examination of the skin looking for new lesions. Current studies, however, are recent and conflicts about this association. Objective: Evaluate the relationship between hydrochlorothiazide use and the risk of developing basal cell carcinoma. Materials and Methods: A population-based case-control study was conducted, collecting cases (histopathological CBC confirmations) of the Pathology Laboratory of the Dermatology Service of the Center for Medical Specialties of the University Center of Pará (CESUPA). Controls were matched 3:1 by age and sex. Data was obtained from medical record or interview. Analytical statistics were used to evaluate the results of the categorical variables of the sample through the G and Chi-squared tests adherence and independence. Odds Ratio was calculated using Logistic Regression, with a 95% confidence interval. Results: We obtained 36 cases of BCC and 108 controls. The use of hydrochlorothiazide increased the risk of developing basal cell carcinoma (Odds Ratio 2.53 and 95% CI 1.04 - 6.14). There seems to be a cumulative dose relationship, evidenced by Odds ratio 2.80 and 95% CI 1.01 - 7.77 for doses greater than or equal to 27,000mg, corresponding to 3 years or more of use, which is not observed at doses lower than this. Conclusion: The use of hydrochlorothiazide increase the risk of developing basal cell carcinoma.