Lisinopril Hair and Skin Changes: What the Evidence Actually Shows

What does the lisinopril label say about hair?

Lisinopril is an ACE inhibitor labeled for hypertension, systolic heart failure, and reduction of mortality after acute MI [1]. Its label lists alopecia among the skin entries in its less common adverse reactions [1].

Which skin reactions are listed?

The label's skin list includes urticaria, alopecia, photosensitivity, erythema, flushing, diaphoresis, cutaneous pseudolymphoma, toxic epidermal necrolysis, Stevens-Johnson syndrome, and pruritus [1]. The post-marketing section adds psoriasis [1]. The label also notes that rash or photosensitivity may occur alone or with a symptom complex that may include a positive ANA, vasculitis, and eosinophilia [1].

Angioedema: the key emergency

Angioedema is the skin-related reaction with the clearest label warning. The label describes angioedema of the face, extremities, lips, tongue, glottis, and/or larynx, including some fatal reactions, at any time during treatment [1]. It says patients with tongue, glottis, or larynx involvement are likely to experience airway obstruction, especially those with a history of airway surgery [1]. The label says lisinopril should be promptly discontinued and appropriate therapy and monitoring provided until complete and sustained resolution [1].

The label also describes intestinal angioedema: abdominal pain with or without nausea or vomiting, in some cases without prior facial angioedema and with normal C1-esterase levels [1]. It notes that ACE inhibitors have a higher rate of angioedema in Black than non-Black patients [1]. A history of angioedema unrelated to ACE inhibitors may increase risk, and concomitant mTOR inhibitors or neprilysin inhibitors raise risk [1].

Lisinopril is contraindicated in patients with a history of angioedema or hypersensitivity related to previous ACE inhibitor treatment and in hereditary or idiopathic angioedema [1]. It is also contraindicated with a neprilysin inhibitor such as sacubitril; the label says not to give lisinopril within 36 hours of switching to or from sacubitril/valsartan [1].

What about rash, photosensitivity, and psoriasis?

Urticaria, erythema, flushing, diaphoresis, pruritus, cutaneous pseudolymphoma, Stevens-Johnson syndrome, and toxic epidermal necrolysis are all listed among the label's skin reactions, alongside photosensitivity [1]. The post-marketing section lists psoriasis [1].