Does tadalafil cause thin skin? This question occasionally arises among patients prescribed this phosphodiesterase type 5 (PDE5) inhibitor for erectile dysfunction or benign prostatic hyperplasia. Tadalafil, available in the UK as Cialis and generic formulations, works by enhancing blood flow through smooth muscle relaxation. Whilst the medication can produce various side effects—including flushing, headache, and nasal congestion—skin thinning is not a recognised adverse reaction in UK regulatory documentation or clinical evidence. Understanding the actual dermatological effects of tadalafil, and distinguishing these from unrelated skin changes, helps patients make informed decisions about their treatment.

What Is Tadalafil and How Does It Work?

Tadalafil is a prescription medication primarily used to treat erectile dysfunction (ED) and benign prostatic hyperplasia (BPH). It belongs to a class of drugs called phosphodiesterase type 5 (PDE5) inhibitors, which also includes sildenafil and vardenafil. In the UK, tadalafil is available under brand names such as Cialis, as well as generic formulations approved by the MHRA.

The mechanism of action centres on the relaxation of smooth muscle tissue within blood vessels. During sexual stimulation, nitric oxide is released in the erectile tissue of the penis, which activates an enzyme called guanylate cyclase. This increases levels of cyclic guanosine monophosphate (cGMP), leading to smooth muscle relaxation and increased blood flow. Tadalafil works by inhibiting PDE5, the enzyme responsible for breaking down cGMP, thereby prolonging its vasodilatory effects and facilitating erections.

Tadalafil is also licensed for treating symptoms of BPH by relaxing smooth muscle in the prostate and bladder, improving urinary flow. Additionally, it is used in pulmonary arterial hypertension under the brand name Adcirca, where it reduces pulmonary vascular resistance. This specialist-only indication has different dosing (typically 40 mg once daily) and is not interchangeable with ED/BPH products.

Dosing varies depending on the indication. For ED, tadalafil may be taken as required (10–20 mg before sexual activity, not more than once in 24 hours) or as a daily low-dose regimen (2.5–5 mg). Its long half-life of approximately 17.5 hours distinguishes it from other PDE5 inhibitors.

Important contraindications include nitrate medications and guanylate cyclase stimulators (such as riociguat), as these combinations can cause dangerous drops in blood pressure. Caution is needed with alpha-blockers, antihypertensives, and strong CYP3A4 inhibitors (e.g., ketoconazole, ritonavir). Grapefruit juice should be avoided. Patients should always discuss their complete medical history with their GP or prescriber before starting treatment.

Common Side Effects of Tadalafil

Like all medications, tadalafil can cause side effects, although not everyone experiences them. The most frequently reported adverse effects are generally mild to moderate and often resolve without intervention. Understanding these helps patients distinguish between expected reactions and those requiring medical attention.

Common side effects (affecting up to 1 in 10 people) include:

• Headache – the most frequently reported side effect, often mild and transient

• Flushing – facial redness or warmth due to vasodilation

• Indigestion or dyspepsia – stomach discomfort or acid reflux

• Nasal congestion – stuffy or runny nose

• Back pain and muscle aches – typically appearing 12–24 hours after taking the medication and resolving within 48 hours

• Dizziness – related to blood pressure changes

These effects result from tadalafil's vasodilatory properties affecting blood vessels throughout the body, not just in the genital area. The medication's action on smooth muscle in various tissues explains symptoms like nasal congestion and muscle discomfort.

Less common but notable side effects include blurred vision, increased heart rate, and hypotension (low blood pressure). Rarely, serious adverse events such as priapism (prolonged erection lasting over four hours), sudden hearing loss, or non-arteritic anterior ischaemic optic neuropathy (NAION) have been reported.

Patients should be aware that alcohol consumption can increase the likelihood of side effects, particularly dizziness and hypotension. The Summary of Product Characteristics and NHS guidance advise minimising alcohol intake when using tadalafil. Most side effects are dose-dependent, and adjusting the dose under medical supervision may improve tolerability whilst maintaining therapeutic benefit.

Skin Changes and Erectile Dysfunction Medications

Concerns about skin thinning in relation to tadalafil occasionally arise in patient queries, but it is important to clarify that skin thinning is not a recognised side effect in the UK SmPC and there is no robust clinical evidence linking tadalafil to dermal atrophy.

Skin changes that are recognised with tadalafil use include:

• Flushing and redness – temporary vasodilation causing facial warmth

• Rash – uncommon, affecting fewer than 1 in 100 people

• Hyperhidrosis (increased sweating) – rare

• Allergic skin reactions – very rare, including Stevens-Johnson syndrome in exceptional cases

These reactions are typically acute and reversible rather than chronic structural changes to skin tissue. Skin thinning (dermal atrophy) is characteristically associated with prolonged use of topical or systemic corticosteroids, certain autoimmune conditions, or natural ageing processes, not with PDE5 inhibitors.

If a patient notices skin changes whilst taking tadalafil, several considerations are important. First, correlation does not imply causation – other medications, underlying health conditions, or age-related changes may be responsible. For instance, patients with diabetes or cardiovascular disease (common in those prescribed ED medications) may experience skin changes related to these conditions rather than the medication itself.

Patients concerned about skin texture or integrity should maintain a comprehensive medication review with their GP. If genuine skin thinning is observed, investigation should focus on other potential causes, including:

• Topical steroid use

• Systemic corticosteroids

• Cushing's syndrome

• Connective tissue disorders

• Nutritional deficiencies

• Chronic sun exposure

• Anticoagulants or antiplatelet medications

• Liver disease or thrombocytopenia

Documenting the timeline of skin changes relative to medication initiation can help establish whether a genuine association exists. Suspected adverse reactions can be reported through the MHRA Yellow Card scheme.

When to Seek Medical Advice About Tadalafil Side Effects

Whilst tadalafil is generally well-tolerated, certain symptoms warrant prompt medical attention. Patients should be educated about red flag signs that require urgent assessment, as well as less urgent concerns that merit routine GP consultation.

Seek immediate medical help if you experience:

• Priapism – an erection lasting more than four hours, which constitutes a medical emergency requiring urgent treatment to prevent permanent erectile tissue damage

• Sudden vision loss – particularly in one eye, which may indicate NAION (attend A&E or eye casualty)

• Sudden hearing loss or tinnitus – rare but documented with PDE5 inhibitors

• Chest pain during or after sexual activity – may indicate cardiovascular compromise (call 999 if severe)

• Severe allergic reactions – including difficulty breathing, facial swelling, or widespread rash (call 999)

• Irregular heartbeat or palpitations with associated chest discomfort

For urgent but non-life-threatening symptoms, contact NHS 111 for advice on appropriate care.

Contact your GP or prescriber within 24–48 hours if you notice:

• Persistent or worsening side effects that affect quality of life

• New skin changes, rashes, or unexplained bruising

• Dizziness or fainting episodes

• Severe indigestion or reflux not responding to usual measures

• Visual disturbances such as blurred vision or light sensitivity

• Muscle pain or back pain lasting beyond 48 hours

Routine medication review is advisable if tadalafil seems ineffective or if your health status changes. NICE guidance recommends regular assessment of cardiovascular risk in men with ED, as erectile dysfunction can be an early marker of cardiovascular disease. Your GP may suggest investigations including blood pressure monitoring, lipid profiles, HbA1c (for diabetes screening), and testosterone levels if clinically indicated.

For ED or BPH treatment, you can stop tadalafil if concerned, but it's best to consult your prescriber. For pulmonary arterial hypertension, always seek specialist advice before making any changes to your medication. If you experience any suspected side effects, you can report them via the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk), which contributes to ongoing medication safety surveillance.

Frequently Asked Questions