“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 (Figure 1 a, b, c) . Dermoscopic examination revealed
red dots and globules that confirmed the vascular nature of skin lesions(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 (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 (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(1) , psoriasis-like eruptions with pravastatin (2) ,
lichenoid eruptions with atorvastatin, simvastatin and rosuvastatin(3,4), and other skin conditions such cutaneous lupus
erythematosus, porphyria cutanea tarda, bullous dermatosis, acute
generalized exanthematous pustulosis, cheilitis, and
dermatomyositis-like syndrome (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 (6) …
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(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.