Could antihypertensive drugs cause eczema in the elderly?

Eczematous skin disease is common. In a previous blog I have written about the common form known as winter itch, a type of the disease which particularly affects the elderly. There is some recent evidence suggesting that eczema in older adults may be triggered by medications, particularly antihypertensives.

Calcium Channel Blockers may increase eczema in the elderly

Introduction

The term eczema is a broad term that defines inflammation within the skin, with many types known to exist. Atopic dermatitis is probably the most well studied as a condition that may arise in early childhood and persist for many years. Much of the focus in research has been aimed at the prevention and treatment of childhood disease. Eczema in older patients has not received so much attention in terms of understanding the disorder.

Eczema in older adults is rising

Eczema arising in older adults is frequently encountered in podiatry clinics as in its most common form – asteototic eczema, it is readily observed on the legs and feet particularly in the colder months, earning its moniker as “winter itch”. Eczema in older adults is a common condition with a prevalence of 11.6% in the UK [1] which is comparative from other studies [2]. Evidence demonstrates that the numbers of cases are rising [3] – 100% since 1991 particularly in more wealthy countries  [4]. The cause of this increase in cases numbers is complex and is probably a reflection of a number of factors, not least increased life expectancy in many countries.

Could eczema be triggered by medication?

Investigating the causes of eczema in the elderly is difficult. Many patients may develop this as a new condition, whilst others may just carry the condition from childhood into older age. Older adults are more likely to be receiving multiple medications. The idea of medications as a potential cause have seldom been investigated. A study published in 2019 demonstrated increased skin dryness in older patients receiving statins and diuretics [5].

A recent study published in the Journal of Investigative Dermatology [6] examined the effects of cardiovascular drugs on eczematous eruptions in older patients. This work was based on the authors earlier observations that for many older patients had forms of eczema that the causation could not be readily identified, however many of these patients were on long term medications including antihypertensives, statins and anxiolytic drugs.  

Identifying potential drugs that increase the risk of eczema

The researchers carefully selected 102 older adults with a diagnosis of eczema of at least three months duration where there was no discernible cause. Each of these cases were matched with two controls who had similar characteristics but had no history of eczema. A statistical analysis was undertaken comparing cases with controls.

Calcium channel blockers increase the risk of eczema

The results showed that patients taking calcium channel blocker antihypertensive drugs were 2.5 times more likely to have eczema. The authors also undertook a withdrawal programme for 54 patients on calcium channel blockers. Within this group 83% who stopped the drugs had clearance of their skin problem lasting more than 6 months. Only 4 patients out of twenty who remained on the drug cleared their eczema during the study.

Implications of this study

This work potentially opens up a whole investigation into what other medications may be capable of triggering eczema in older adults. Statins, another popular medication is well known for increasing dry skin in patients taking the drug. One small study demonstrated a fourfold increase in eczema in patients taking the drug [7].

Of course, the link between antihypertensive use and eczema could be a chicken and egg scenario. A systematic review showed that patients with atopic dermatitis were more likely to have hypertension [8]. Could that be confounded by the fact that by taking their hypertensive medication they were more likely to develop atopic eczema?

The current study highlighted calcium channel blockers as a potential cause of eczema. In the UK, these drugs are very commonly prescribed to older patients with hypertension and angina. Drugs of this type include amlodipine, nifedipine, diltiazem, felodipine, verapamil and lercanidipine.

Overall, this work is another piece of the incomplete jigsaw that is eczema. As a multifactorial disease there is little doubt behaviours such as overbathing and skin care routines in the older patient maybe triggering dry skin and eczema. Addressing these issues can go a long way to improve skin health. However, for some older patients, a review of their medication maybe the key to improving their skin health further.

References

1.            Chan, L.N., et al., The epidemiology of atopic dermatitis in older adults: A population-based study in the United Kingdom. PLOS ONE, 2021. 16(10): p. e0258219.

2.            Wang, X. and L.-F. Li, Clinical features of eczema and dermatitis in the elderly: A cross-sectional study in mainland China. European Journal of Inflammation, 2022. 20: p. 20587392211069758.

3.            Teng, Y., et al., Current and Emerging Therapies for Atopic Dermatitis in the Elderly. Clinical Interventions in Aging, 2023. Volume 18: p. 1641–1652.

4.            Ou, Y., et al., Global, regional, and national burden of older adult atopic dermatitis in 204 countries and territories worldwide. Frontiers in Public Health, 2025. 13.

5.            Mekic, S., et al., Prevalence and determinants for xerosis cutis in the middle-aged and elderly population: A cross-sectional study. J Am Acad Dermatol, 2019. 81(4): p. 963–969.e2.

6.            Joly, P., et al., Chronic Eczematous Eruptions of the Elderly Are Associated with Chronic Exposure to Calcium Channel Blockers: Results from a Case–Control Study. Journal of Investigative Dermatology, 2007. 127(12): p. 2766–2771.

7.            Cheung, K., et al., Effect of statin use on incidence of eczema and atopic dermatitis: A retrospective cohort study. J Am Acad Dermatol, 2021. 84(2): p. 534–535.

8.            Yousaf, M., et al., Association between atopic dermatitis and hypertension: a systematic review and meta‐analysis*. British Journal of Dermatology, 2022. 186(2): p. 227–235.