Losartan Hair and Skin Changes: What Patients and Clinicians Need to Know

What skin reactions does losartan's label list?

The losartan potassium label separates skin reactions into two groups. In hypertension trials that included more than 1,000 patients on losartan 10 to 150 mg and more than 300 on placebo, the adverse reactions occurring in at least 2% of patients and more often than placebo were dizziness (3% vs 2%), upper respiratory infection (8% vs 7%), nasal congestion (2% vs 1%), and back pain (2% vs 1%) [1]. Skin reactions are on the less-common list: urticaria, pruritus, rash, and photosensitivity [1].

The post-marketing section adds erythroderma under Skin [1]. It also lists angioedema, vasculitis including Henoch-Schönlein purpura, and anaphylactic reactions under hypersensitivity [1].

Does losartan cause hair loss?

Alopecia is not named in the label's clinical-trial or post-marketing adverse reaction sections [1]. The label therefore gives no frequency, shedding pattern, or recovery timeline for hair loss with losartan [1].

How does the label describe angioedema?

Angioedema appears under post-marketing hypersensitivity, not in the common trial table [1]. The label describes swelling of the face, lips, pharynx, tongue, larynx or glottis that can obstruct the airway, and swelling of the intestine [1]. Some patients with angioedema on losartan had earlier angioedema with other drugs, including ACE inhibitors [1].

Anaphylactic reactions and vasculitis, including Henoch-Schönlein purpura, are also listed [1].

Are psoriasis, lichenoid eruptions, and bullous pemphigoid on the label?

The label's skin entries are urticaria, pruritus, rash, photosensitivity, and erythroderma [1]. Psoriasis, lichenoid drug eruption, and bullous pemphigoid are not among them [1].

What about the hydrochlorothiazide combination?

Hyzaar contains losartan plus hydrochlorothiazide. A Danish case-control study of nonmelanoma skin cancer examined hydrochlorothiazide, not losartan alone. It found that high cumulative hydrochlorothiazide use (50,000 mg or more) was associated with an odds ratio of 1.29 for basal cell carcinoma and 3.98 for squamous cell carcinoma [2]. The highest category (200,000 mg or more) had odds ratios of 1.54 and 7.38 [2]. Other diuretics and antihypertensives were not associated with nonmelanoma skin cancer in that study [2]. The study had no data on sun exposure [2].