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\begin{document}

\title{Rosuvastatin induced photolocalized purpura}



\author[1]{Marwa THABOUTI}%
\author[2]{Nadia Ghariani Fetoui}%
\author[3]{Linda Manaa}%
\author[3]{Jacem Rouatbi}%
\author[1]{Baderedine Sriha}%
\author[1]{Chaker Ben Salem}%
\author[1]{Mohamed Denguezli}%
\affil[1]{Farhat Hached University Hospital of Sousse}%
\affil[2]{Centre Hospitalier Universitaire Farhat Hached de Sousse}%
\affil[3]{Fattouma Bourguiba University Hospital of Monastir}%


\vspace{-1em}



  
  \date{May 24, 2024}


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\selectlanguage{english}
\begin{abstract}
Statins are a widely used class of drug, usually safe and
well-tolerated. Their cutaneous side effects are exceedingly rare. We
describe a case of photoexposed purpuric eruption mediated by
rosuvastatin.%
\end{abstract}%



\sloppy


\textbf{Rosuvastatin induced photolocalized purpura}

Marwa Thabouti\textsuperscript{a}, Nadia Gahriani
Fetoui\textsuperscript{a}, Linda Manaa\textsuperscript{a,} Jassem
Rouatbi\textsuperscript{a}, Badreddine Sriha\textsuperscript{b}, Chaker
Ben Salem\textsuperscript{c} Mohamed Denguezli\textsuperscript{a}

\textsuperscript{a} Dermatology Department, Farhat Hached Hospital,
Sousse, Tunisia.

\textsuperscript{b} Anatomopathology Department, Farhat Hached Hospital,
Sousse, Tunisia.

\textsuperscript{c} Pharmacology Department, Farhat Hached Hospital,
Sousse, Tunisia.

\textbf{Short Title:} Rosuvastatin induced purpura.

\textbf{Corresponding Author:} Marwa Thabouti, Derrmatology Department,
Farhat Hached Hospital, Sousse, Tunisia, Tel: +21650553815, E-mail:
hebek2011@live.com

\textbf{Number of Figures:} 2.

\textbf{Word count:} 430.

\textbf{Keywords:} Photosensitivity, Rosuvastatin, photolocalized
purpura.

\textbf{``Written informed consent was obtained from the patient to
publish this report in accordance with the journal's patient consent
policy''}

Dear Editor,

Statins are a widely used class of drug, usually safe and
well-tolerated. Their cutaneous side effects are exceedingly rare. We
describe a case of photoexposed purpuric eruption mediated by
rosuvastatin.

A 65-year-old woman presented with a 6-day history of pruritic eruption
of the face. She had a clinical history of hypercholesterolemia
diagnosed one month ago and treated by rosuvastatin 10 mg once a day.
Fifteen days After the treatment was started, the patient reported the
occurrence of a pruriginous eruption on the face. Dermatological
examination showed isolated and confluent punctate lesions on an
erythematous background, located on the cheeks, the tip of the nose and
the chin \textbf{(Figure 1 a, b, c)} . Dermoscopic examination revealed
red dots and globules that confirmed the vascular nature of skin
lesions\textbf{(Figure 1d} ). Personal and family medical history was
negative for photomediated diseases. Her laboratory parameters were
within normal limits. Histopathological examination showed lymphocytic
infiltrate around capillaries in the dermis without signs of vasculitis.
There was a marked degree of extravasation of red blood cells
\textbf{(Figure 2a)} . No immunoreacting deposits were found in direct
immunofluorescence studies. The diagnosis of photoexposed purpuric
eruption induced by rosuvastatin was made, based on clinical,
dermoscopic and histopathological findings. Rosuvastatin was
discontinued and the patient was prescribed topical betamethasone
dipropionate 0.05\% cream twice daily for three weeks, with
photoprotection measures. The skin eruption completely resolved within
10 days (\textbf{Figure 2b)} .

3-Hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) are
extensively used for the primary and secondary prevention of
atherosclerotic cardiovascular events. A wide spectrum of cutaneous
reactions has been described with statins, notably, acral cutaneous
vesiculobullous and pustular lesions mainly with simvastatin\textbf{(1)}
, psoriasis-like eruptions with pravastatin \textbf{(2)} , lichenoid
eruptions with atorvastatin, simvastatin and rosuvastatin\textbf{(3,4),}
and other skin conditions such cutaneous lupus erythematosus, porphyria
cutanea tarda, bullous dermatosis, acute generalized exanthematous
pustulosis, cheilitis, and dermatomyositis-like syndrome \textbf{(5)} .
Statins are less likely to induce photosensitivity. A few cases of
photolocalized erythema multiform have been described with simvastatin
and pravastatin, eczematous and lichenoid photosensitivity with
fenofibrates and chronic actinic dermatitis has been described with
simvastatin \textbf{(6)} \ldots{}

Our patient presented a petechial purpura, without vasculitis, 15 days
after starting rosuvastatin therapy. strictly, limited to her face,
which was the only sunlight-exposed areas. This uncommon skin reaction
was only described with levofloxacin and ciprofloxacin
therapy\textbf{(7,8)} .

To the best of our knowledge, this is the first case of photolocalized
purpuric eruption associated with Rosuvastatin. Its etiopathogenesis is
not yet elucidated. Physicians should be aware of this skin reaction,
which could be added to the spectrum of statin induced photosensitivity
eruptions.

\textbf{No Acknowledgement.}

\textbf{The authors have no conflicts of interest to declare.}

\textbf{No Funding Sources}

\textbf{References:}

1- Amy E. Adams, Arthur M. Bobrove, Anita C. Gilliam, Statins and
``Chameleon-Like'' Cutaneous Eruptions: Simvastatin-Induced Acral
Cutaneous Vesiculobullous and Pustular Eruption in a 70-Year-Old Man,
Journal of Cutaneous Medicine and Surgery, September 1, 2010, page(s):
207-211.

2- Michael P. Salna, Hannah M. Singer, and Ali N. Dana,
Pravastatin-Induced Eczematous Eruption Mimicking Psoriasis, Case
Reports in Dermatological Medicine, Volume 2017, Article ID 3418204, 4
pages.

3- Forouzan P, Riahi R R, Cohen P R (March 01, 2020)
Atorvastatin-induced Lichenoid Drug Eruption: A Case Report and Review
of Statin-associated Cutaneous Adverse Events. Cureus 12(3): e7155.
doi:10.7759/cureus.7155.

4- Vesza Z, Pires C, da Silva PM. Statin-related lichenoid dermatosis:
an uncommon adverse reaction to a common treatment. EJCRIM 2018;5:
doi:10.12890/2018\_000844.

5 Jowkar F, Namazi MR. Statins in dermatology. Int J Dermatol. 2010;
49:1235--1243.

6- Ana Filipe Monteiro, Margarida Rato, C\selectlanguage{ngerman}ésar Martins, Drug-induced
photosensitivity: Photoallergic and phototoxic reactions, Clin Dermatol.
Sep-Oct 2016;34(5):571-81

7- Pietro Rubegni, Luca Feci, Michele Pellegrino \& Michele Fimiani,
Photolocalized purpura during levofloxacin therapy, Photodermatology,
Photoimmunology \& Photomedicine 2012, 28, 105--107

8- Francisco Urbina, Moema Barrios, Emilio Sudy, Photolocalized purpura
during ciprofloxacin therapy, Photodermatol Photoimmunol Photomed. 2006
Apr;22(2):111-2.

\textbf{Figure Legends}

\textbf{Figure 1: a,b,c:} Punctate lesions on an erythematous
background, located on the cheeks, the tip of the nose and the
chin.\textbf{d:} Red dots and globules in dermoscopic examination.

\textbf{Figure 2 a:} HE*200: Lymphocytic infiltrate around capillaries
in the dermis and extravasation of red blood cells without signs of
vasculitis, \textbf{b:} The skin eruption completely resolved.\selectlanguage{english}
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