Please login or create an account. If you do not have access to this content, you will be shown a 30 second preview and licensing options.
- Presentation
Cardiac Complications and Monitoring for Dermatologic Drugs
Description
The talk reviewed cardiac adverse effects and monitoring for several dermatologic drugs, focusing on JAK inhibitors, MEK inhibitors, PD-1 inhibitors, and low-dose oral minoxidil. For JAK inhibitors used in atopic dermatitis, alopecia areata, and psoriasis, the main concerns are MACE, MI, thrombosis, and mortality, with risk appearing higher in older patients, especially those over 65 and those with cardiovascular risk factors such as hypertension, obesity, hyperlipidemia, tobacco use, atrial fibrillation, or prior cardiovascular events. The mechanism is thought to involve JAK2 effects on lipids and platelets, potentially destabilizing plaque; monitoring should include cardiovascular risk assessment, CBC, lipids, patient counseling on warning symptoms, and holding therapy during infections such as COVID. MEK inhibitors used for melanoma and plexiform neurofibromas can cause cardiomyopathy, heart failure, and QTc prolongation, with reversible reductions in left ventricular function seen in trials; baseline and follow-up echocardiography and cardiac monitoring are recommended. PD-1 immune checkpoint inhibitors can cause immune-related myocarditis, arrhythmias, and heart block, usually early in treatment and more often with combination therapy; symptoms may be subtle, so baseline and routine cardiac evaluation and vigilance for fatigue, dyspnea, and palpitations are important. Low-dose oral minoxidil, used off-label for hair disorders, may cause hypotension, tachycardia, edema, pericarditis/pericardial effusion, and arrhythmias; clinicians should screen for hypotension, syncope, renal dysfunction, lupus, and pre-existing arrhythmias, counsel on fluid-related side effects, and monitor heart rate and symptoms, with cardiology involvement when needed.
View moreConclusions
- JAK inhibitors appear to carry the greatest cardiovascular concern in older patients and those with existing cardiovascular risk factors, especially when JAK2 is affected, with risks centered on MACE, MI, and thrombosis.
- Among JAK inhibitors used for atopic dermatitis and alopecia areata, cardiovascular event rates are generally low but rise with age, longer exposure, and baseline cardiovascular risk.
- Because the JAK inhibitors are not identical, their relative JAK selectivity matters, with more JAK2 activity generally implying more concern for lipid and platelet effects.
- Risk assessment before starting a JAK inhibitor should include formal cardiovascular risk estimation, review of prior events and hormone therapy, and shared decision-making about whether the benefit outweighs the risk.
- Patients on JAK inhibitors should be counseled about warning symptoms such as chest pain, dyspnea, and leg swelling, and clinicians should monitor CBC and lipids and hold treatment during significant infection.
- MEK inhibitors can cause reversible cardiac dysfunction, including decreased left ventricular ejection fraction, cardiomyopathy, heart failure, and QTc prolongation.
- Cardiac effects from MEK inhibitors are important enough that baseline and follow-up echocardiography and other cardiac monitoring are recommended, especially in patients with other risk factors.
- Immune checkpoint inhibitors can cause rare but often severe myocarditis, usually early in treatment, with higher risk when dual checkpoint therapy is used.
- The cardiac toxicity of PD-1 inhibitors includes myocarditis, arrhythmias, and heart block, so even mild nonspecific symptoms in the first treatment year warrant attention and workup.
- Low-dose oral minoxidil is usually tolerated, but it can produce small blood pressure and heart-rate changes, with hypotension, tachycardia, edema, pericardial effusion, and arrhythmias as the main concerns.
- For low-dose oral minoxidil, most adverse effects seem uncommon and often mild, but clinicians should be especially cautious in patients with hypotension, syncope, renal disease, lupus, or pre-existing arrhythmias.
- Overall, the presentation supports using medication-specific cardiovascular screening and monitoring rather than treating all dermatologic therapies as having the same cardiac risk profile.
- Factors. Dermis. 5(3):41.
- Adv Ther. 2023;40(4):1867-1883.
- JACC: CardioOncology
- JACC Basic Trans Science
- JAMA Oncology 2024
- JAMA Oncology 2026
- Molecular Neurobiology (2025) 62:9170
- J. Clin. Med. 2025, 14, 1805.