A two-part continuing education review sets out what systemic dermatological treatments do to cardiovascular and metabolic health. Part I covers the older workhorses: retinoids and rexinoids, anthracyclines, antifungals, oral minoxidil, methotrexate, ultraviolet phototherapy and colchicine.
The effects run both ways. Some of these agents worsen lipids, glucose handling or cardiac function; others — methotrexate and colchicine among them — carry a plausible protective signal in inflammatory disease. The review pairs the mechanism for each with practical workup and monitoring advice, and argues for routine coordination with cardiology, endocrinology and primary care rather than dermatology managing the consequences alone.
The useful reframing is that a dermatological prescription in a patient with psoriasis, hidradenitis or alopecia lands in someone who already carries raised cardiovascular risk from the disease itself. Oral minoxidil for hair loss is the clearest example of a drug now prescribed at volume, often to otherwise well patients, whose cardiovascular monitoring is inconsistent.
- Record a baseline lipid profile and fasting glucose before starting systemic retinoids
- Take a cardiac history and baseline blood pressure and pulse before oral minoxidil, and review at follow-up
- Check interactions with statins and antihypertensives before starting an azole antifungal
- Name the monitoring owner explicitly — dermatology or primary care — rather than assuming
- In psoriasis, treat cardiovascular risk assessment as part of the skin consultation
Why it matters
These prescriptions land in patients whose disease already raises their cardiovascular risk.
Don't overread it
This is a narrative continuing-education review, not new comparative evidence on any one drug.
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