Statins and the skin: systematic review of dermatologic reactions to statin therapy

Abstract

Statins are widely prescribed medications for lowering cholesterol levels. While generally well-tolerated, they can cause various cutaneous adverse reactions through disruption of the mevalonate pathway, affecting immune cell function and potentially triggering autoimmune responses. Aim was to systematically evaluate the clinical and histopathologic features of statin-associated cutaneous adverse reactions and review reported management strategies. A systematic review following PRISMA guidelines using PubMed, Embase, and Scopus databases was conducted analyzing cutaneous adverse reactions associated with statin therapy, including clinical presentation, histopathologic features, and management strategies. Inclusion criteria encompassed case reports, randomized controlled trials, and observational studies investigating statin-induced cutaneous adverse effects in human subjects. Studies were excluded if they were animal trials, systematic reviews, literature reviews, or did not focus on statin-related cutaneous reactions. The 22 published cases were identified, affecting patients with a mean age of 61 years (range: 44-84) and slight female predominance. The most frequently reported reactions were eczematous eruptions (6 cases), lichenoid drug eruptions (4 cases), dermatomyositis (DM) (4 cases), and pityriasis lichenoides chronica (PLC) (3 cases). Additional manifestations included lupus erythematosus tumidus (LET), pemphigus erythematosus, erythema multiforme, fixed drug eruption, and thrombocytopenic purpura. Histopathologic features commonly showed immune-mediated patterns including interface dermatitis, basal vacuolar changes, and lymphocytic infiltrates. Most cases resolved following statin discontinuation, though some required adjunctive corticosteroids or immunosuppressive therapy. This review adds to the body of literature by highlighting the breadth of statin-associated cutaneous adverse effects, emphasizing the need for clinicians to maintain a high index of suspicion when evaluating new skin eruptions in patients on statin therapy. Prompt identification and tailored management can lead to improved patient outcomes and medication safety.