Atorvastatin and skin rash

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Atorvastatin and Skin Rash: A Review of Adverse Reactions

Introduction to Atorvastatin and Skin Reactions

Atorvastatin, a widely used HMG-CoA reductase inhibitor, is primarily prescribed for the prevention of atherosclerotic cardiovascular disease and the treatment of hypercholesterolemia. Despite its efficacy, atorvastatin has been associated with various adverse skin reactions, ranging from mild rashes to severe conditions like toxic epidermal necrolysis (TEN) and drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome.

Dermatomyositis Induced by Atorvastatin

One notable case involved a 49-year-old man who developed dermatomyositis after starting atorvastatin therapy post-myocardial infarction. The patient exhibited a reddish rash on the face and Gottron’s papules on the knuckles, along with proximal muscle weakness. A skin biopsy confirmed the diagnosis, and the symptoms resolved after treatment with prednisolone .

Toxic Epidermal Necrolysis (TEN) and Atorvastatin

Toxic epidermal necrolysis is a rare but severe adverse reaction characterized by extensive skin exfoliation. A 68-year-old woman developed TEN after starting atorvastatin following mitral valve replacement. The patient exhibited more than 30% skin exfoliation, and genetic testing revealed specific HLA alleles that may predispose individuals to this reaction. The condition improved after discontinuation of atorvastatin and administration of antiallergic drugs 25.

Angioedema Associated with Atorvastatin

Angioedema, characterized by mucosal and submucosal swelling, has also been linked to atorvastatin. In one case, a 79-year-old woman experienced facial and periorbital swelling, edema, and generalized itching after her atorvastatin dose was increased from 20 mg to 40 mg daily. The symptoms resolved upon discontinuation of the drug . Another case involved a 59-year-old man who developed recurrent angioedema of the face and tongue shortly after starting atorvastatin, which resolved after stopping the medication .

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome

DRESS syndrome is a severe hypersensitivity reaction that can occur weeks to months after starting a drug. A 77-year-old woman developed a progressive rash, kidney, and liver dysfunction six weeks after starting atorvastatin. Laboratory tests and a skin biopsy confirmed the diagnosis of DRESS syndrome. The patient’s condition improved significantly after discontinuing atorvastatin and initiating steroid therapy .

Other Skin Reactions: Dermographism and Drug Eruptions

Dermographism, or skin writing, is a type of physical urticaria that can manifest as pruritic linear wheals and erythema. Although rare, it has been reported in association with atorvastatin use . Additionally, a case of drug eruption initially misdiagnosed as tinea cruris was reported in a 68-year-old man. The rash resolved after discontinuing atorvastatin .

Conclusion

While atorvastatin is effective in managing hypercholesterolemia and preventing cardiovascular events, it can cause a range of skin reactions, from mild rashes to severe conditions like TEN and DRESS syndrome. Healthcare providers should be aware of these potential adverse effects and monitor patients closely, especially when initiating or increasing the dose of atorvastatin. Discontinuation of the drug and appropriate medical intervention can lead to resolution of symptoms in most cases.

Sources and full results

Most relevant research papers on this topic

Atorvastatin-induced dermatomyositis

Atorvastatin-induced dermatomyositis can be effectively treated with prednisolone therapy, reducing symptoms in a patient with a history of musculoskeletal problems.

Case ReportRigorous Journal

2017·

19citations

·M. Oztaset al.

Rheumatology International

Reporting on Adverse Clinical Events

Toxic epidermal necrolysis may be associated with atorvastatin, particularly in patients with mutant HLA genotypes.

Case Report

2021·

0citations

Clin-Alert®

Dose-dependent atorvastatin associated with angioedema.

Atorvastatin use may be associated with angioedema, especially when increasing doses or prescribing with medications known to cause angioedema.

Case Report

2021·

1citation

·Ayman M. Al-Qaanehet al.

International journal of clinical pharmacology and therapeutics

Drug Eruption From Atorvastatin: With Initial Misdiagnosis of Tinea Cruris.

Atorvastatin may cause a new onset rash, and pharmacists should consider HMG-CoA reductase inhibitors as a potential cause and avoid retrial of alternative statins.

Case Report

2023·

0citations

·Kimberly Hansonet al.

The Senior care pharmacist

Toxic epidermal necrolysis in a patient on atorvastatin therapy expressing human leukocyte antigen alleles

Aatorvastatin may induce toxic epidermal necrolysis in HLA alleles carriers, requiring caution for these individuals to avoid severe skin adverse reactions.

Case ReportVery Rigorous Journal

2021·

2citations

·M. Lvet al.

Medicine

PSUN62 A Rare Case of Atorvastatin Induced Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome - A Case Report.

Atorvastatin-induced DRESS syndrome can cause rash, hematological abnormalities, lymphadenopathy, and multi-system involvement, but this case report highlights the need for prompt diagnosis and treatment.

Case ReportRigorous Journal

2022·

18citations

·Bilal Ashrafet al.

Journal of the Endocrine Society

Atorvastatin as a Rare Primary Cause of Drug-Induced Angioedema: A Case Report

Atorvastatin can cause rare cases of drug-induced angioedema, affecting the face and tongue, which resolve after discontinuing the drug.

Case ReportRigorous Journal

2022·

2citations

·D. Voloshynaet al.

Cureus

Dermographism: an adverse effect of atorvastatin.

Atorvastatin may cause dermographism, a skin reaction caused by minor trauma, but its cause remains unclear.

Case Report

2001·

23citations

·Bobbi B. Adcocket al.

The Journal of the American Board of Family Practice

Reintroduction of Statin After a Nonimmediate Allergic Reaction.

Reintroducing atorvastatin after a nonimmediate allergic reaction can cause a variety of side effects, including pruritic rash, hives, joint pain, and diarrhea.

Case Report

2020·

0citations

·S. Sandhuet al.

Dermatitis

Atorvastatin

Myositis: case report A 44-year-old man developed myositis during treatment with atorvastatin for dyslipidaemia. The man presented with pleuritic chest pain, productive cough and rapidly progressive shortness of breath for a duration of two weeks. A provisional diagnosis of pneumonia was considered and initially treated with amoxicillin/clavulanic acid, but failed to show response. He was thus admitted to a hospital due to generalised myalgia, worsening of fatigue, arthralgia, fever, earache, sore throat and reduced effort tolerance. He also showed peeling of skin from both palms. His ongoing home medications included atorvastatin [dosage and route not stated] for dyslipidaemia, cilazapril for hypertension and metformin for diabetes. During the course of hospitalisation, his initial laboratory examination showed elevated creatine kinase (CK) 482 U/L. A diagnosis of atorvastatin-induced myositis was thus made [duration of treatment to reaction onset not stated]. The therapy with atorvastatin was therefore discontinued. Roxithromycin was initiated for the underlying bi-basal pneumonia. A good response to roxithromycin was observed. He was then discharged and followed-up on outpatient basis. After two weeks, he was admitted again due to complaints of similar respiratory symptoms, along with painful joints and new onset of rash on the face, chest and back. A weight loss of 9 kg since the onset of his illness was also noted. A repeat CK was found to be decreased compared to previous value, but was still high (424 U/L). Upon further examination, he was finally diagnosed with anti-MDA5-associated dermatomyositis. Although, a contributory role of atorvastatin in development of myositis could not be ruled out. A rapidly progressive interstitial lung disease (ILD) was also diagnosed [aetiology not stated]. He was therefore treated with methylprednisolone followed by prednisone. The rash and dyspnoea responded well to the treatment. He was discharged in good condition with ongoing treatment with ciclosporin, prednisone and cotrimoxazole. After two weeks, he was admitted to the ICU due to respiratory distress from ILD. He was aggressively treated with cyclophosphamide, methylprednisolone, immune globulin [immunoglobulin] and rituximab. Although, he showed a rapid deterioration of his ILD. Eventually, he died within 12 weeks from the onset of initial symptoms.

Case Report

2020·

0citations

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