Systemic dermatological treatment is increasingly long-term, and several of the drugs used for psoriasis, hair loss and onychomycosis act on cardiovascular and metabolic health - some adversely, some protectively. This first part of a two-part continuing education review covers the traditional agents: retinoids and rexinoids, anthracyclines, antifungals, oral minoxidil, methotrexate, ultraviolet phototherapy and colchicine.
It sets out the mechanisms by which each affects cardiometabolic disease and gives practical recommendations for work-up and monitoring, including where a preventive medication may be indicated alongside the dermatological treatment. The framing throughout is multidisciplinary - dermatology, cardiology, endocrinology, rheumatology, oncology and primary care - and the argument is that awareness has to precede referral, because the dermatologist is usually the only person watching the drug.
The reason this belongs at the end of an edition rather than filed as a review is that it converts into an audit you can run this week. Take your list of patients on long-term oral retinoid, oral minoxidil or methotrexate, and check when each last had lipids, glucose and blood pressure recorded. Oral minoxidil in particular has moved from niche to routine in hair clinics faster than monitoring practice has followed it. Where the answer is 'not in the last year', the review gives you the schedule to fix it against.
- Audit your long-term systemic patients for a recorded lipid profile, glucose and blood pressure in the last twelve months.
- Oral minoxidil use has expanded quickly in hair clinics; make sure monitoring expanded with it.
- Retinoids need baseline and follow-up lipids and liver function - the cardiometabolic effect is not a side note.
- Methotrexate's cardiometabolic profile differs from the others in this list; do not apply one monitoring schedule to all of them.
- Write the referral question when you refer - 'started on X, needs cardiometabolic risk assessment' gets a better answer than a bare referral.
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