Angiotensin converting enzyme and angiotensin converting enzyme inhibitors in dermatology: a narrative review

ABSTRACT

Introduction

Angiotensin converting enzyme inhibitors (ACEI) are commonly used for cardiovascular diseases. The evidence supporting the use of ACEI in dermatology is limited.

Areas covered

This review article was divided into three parts. The first part discusses ACEI in clinical use in dermatology. The second part reveals the relationship between angiotensin converting enzyme (ACE) and immune diseases, and further discusses the possible relationship between ACEI in clinical use in these diseases and ACE. The third part focuses on cutaneous adverse reactions of ACEI.

Expert opinion

The use of ACEI in dermatology is mainly based on its properties as regulation of renin angiotensin system (RAS), but currently, with limited clinical use. The association of ACE and several diseases are well discussed, including COVID-19, psoriasis, sarcoidosis, systemic lupus erythematosus and vitiligo. The main cutaneous adverse effects of ACEI include angioedema, psoriasis and pemphigus. Plausible factors for these adverse reactions include accumulation of vasoactive mediators, preventing angiotensin from binding to AT₁ receptor and AT₂ receptor and presence of circulating antibodies.

KEYWORDS:

• Angiotensin converting enzyme inhibitors
• angiotensin converting enzyme
• dermatology
• treatment
• cutaneous reaction
• adverse drug reaction
• COVID-19

Article highlights

• Angiotensin converting enzyme inhibitors (ACEI) are one of the treatment options for coronavirus disease 2019 (COVID-19) vaccine induced delayed inflammatory reaction to dermal hyaluronic acid fillers, keloids and hypertrophy scars.

• Some studies exist regarding the use of ACEI for anal fissure, infantile hemangioma and delayed effects of radiation, but limited evidence supports the efficacy and further studies are needed.

• ACE is associated with several diseases in dermatology, including COVID-19, psoriasis, sarcoidosis, systemic lupus erythematosus and vitiligo.

• There are several mucocutaneous adverse drug reactions from ACEIs, such as angioedema, Kaposi’s sarcoma, pemphigus, pemphigoid and psoriasis. Others are usually mild, including alopecia, lichenoid drug eruptions, psoriasis, pseudolymphoma, photosensitivity, acquired brachial cutaneous dyschromatosis, eczematous reaction, and pityriasis rosea.

Declaration of interest

T-F Tsai has conducted clinical trials or received honoraria for serving as a consultant for AbbVie, Boehringer Ingelheim, Celgene, Eli Lilly, Galderma, GSK-Stiefel, Janssen-Cilag, Leo-Pharma, Merck, Novartis, Pfizer and Serono International SA (now Merck Serono International). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.