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Lichenoid drug eruption induced by pravastatin; it is possible to prescribe other statins?
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Clinical</span>" "titulo" => "Lichenoid drug eruption induced by pravastatin; it is possible to prescribe other statins?" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "116" "paginaFinal" => "117" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Francisco J. Navarro-Triviño, Ricardo Ruiz-Villaverde" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Francisco J." "apellidos" => "Navarro-Triviño" "email" => array:1 [ 0 => "fntmed@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Ricardo" "apellidos" => "Ruiz-Villaverde" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Contact Eczema and Immunoallergic Diseases, Dermatology, Hospital Universitario San Cecilio, Granada, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Dermatology, Hospital Universitario San Cecilio; Instituto Biosanitario de Granada, Granada, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1051 "Ancho" => 3341 "Tamanyo" => 459595 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0060" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) multiples shiny and violaceous erythematous-squamous plaques on the trunk and (B) lumbar area.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Lichenoid drug eruptions are uncommon and may be difficult to differentiate from idiopathic lichen planus. Clinical and histopathological features are extremely similar in both diseases. Lichenoid drug eruptions caused by HMG-CoA reductase inhibitors are exceptional.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 59-year-old caucasian man was attended to our outpatient dermatological clinic (Hospital Universitario San Cecilio, Granada, Spain) complaining of a 2-month history of pruritic eruption located on his chest and lumbar area. No previous history of any dermatological conditions was referred. His general practitioner prescribed Pravastatin/Fenofibrate (Pravafenix® 40/160<span class="elsevierStyleHsp" style=""></span>mg) for the treatment of hypercholesterolemia and hypertriglyceridemia 3 months ago. The patient was referred to our department with clinical suspicion of plaque psoriasis. Physical examination showed multiple shiny and violaceous erythematous-squamous plaques on the trunk and lumbar area (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Wickham’s striae could not be stated with dermoscopy. Mucosal examination showed no abnormalities. The histopathological study revealed a lichenoid inflammatory infiltrate with intense involvement of the dermo-epidermal interface associated with apoptotic keratinocytes and melanophages in the papillary dermis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Lichenoid eruption due to pravastatin was then concluded. Pravastatin was discontinued and changed to fluvastatine. Fenofibrate was not discontinued. Topical corticosteroid treatment (mometasone furoate 0.1% cream, 1 day) was applied during the first seven days. Residual brownish hyperpigmentation was observed at 3 months of follow-up.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Statins are a commonly prescribed medication for the treatment of hypercholesterolemia. A limited number of case reports of lichenoid drug eruption associated with statins have been reported to date.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The most frequently reported adverse dermatological reaction is an eczematous rash or hypersensitivity eruption. Atorvastatin, lovastatin, and simvastatin are the statins associated with the most adverse effects, including photosensitivity, urticaria, lupus-like syndrome, and pruritus, among others.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The mechanism of statin-induced cutaneous eruptions is not well understood. The anti-inflammatory effects of statins could be related to both beneficial effects and the development of these side effects. The cell-mediated autoimmune reactions against basal layer keratinocytes are thought to be involved.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Pravastatin does not undergo metabolism by CYP enzymes, unlike simvastatin, lovastatin, atorvastatin, and rosuvastatin. These drugs undergo their metabolism in the liver by cytochrome P450 CYP3A3 and CYP2C9 AV.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> This could possibly explain why our patient did not continue with the lichenoid eruption after starting fluvastatine. These metabolites could be related to the development of skin eruption. A few cases of lichenoid eruption induced by pravastatin have been reported.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Moreover, psoriasis-like eczematous lesions have been reported with pravastatin.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Both skin reactions tend to be resistant to topical corticosteroid treatments, and even to systemic treatments. Stopping the use of pravastatin will lead to the resolution of the clinical course. Although fluvastatine has been well tolerated by our patient, ezetimibe is considered a first-line therapy in the case of proven intolerance to statins.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> A case of recurrence of lichenoid eruption has been described in a patient who stopped rosuvastatin and was switched to simvastatin. The choice of a new therapeutic line should imply avoiding first-pass liver metabolism. Finally, our patient developed a score of 6 in the Naranjo algorithm, so the causal relationship was considered probable.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0020" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Author’s contribution</span><p id="par0025" class="elsevierStylePara elsevierViewall">Francisco J. Navarro-Triviño: Approval of the final version of the manuscript; critical literature review; data collection, analysis and interpretation; effective participation in research orientation; intellectual participation in propaedeutic and/or therapeutic; management of studied cases; manuscript critical review; preparation and writing of the manuscript; statistical analysis; study conception and planning.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Ricardo Ruiz-Villaverde: Approval of the final version of the manuscript; critical literature review; data collection, analysis and interpretation; effective participation in research orientation; intellectual participation in propaedeutic and/or therapeutic; management of studied cases; manuscript critical review; preparation and writing of the manuscript; statistical analysis; study conception and planning.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Author’s contribution" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-02-03" "fechaAceptado" => "2021-02-20" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Department of Dermatology, Hospital Universitario San Cecilio, Granada, Spain.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1051 "Ancho" => 3341 "Tamanyo" => 459595 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0060" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) multiples shiny and violaceous erythematous-squamous plaques on the trunk and (B) lumbar area.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1208 "Ancho" => 3341 "Tamanyo" => 1047460 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0065" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) Lichenoid inflammatory infiltrate with intense involvement of the dermo-epidermal interface (Hematoxylin & eosin, ×100). 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| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 21 | 5 | 26 |
| 2024 Outubro | 134 | 97 | 231 |
| 2024 Setembro | 191 | 117 | 308 |
| 2024 Agosto | 201 | 156 | 357 |
| 2024 Julho | 166 | 104 | 270 |
| 2024 Junho | 154 | 72 | 226 |
| 2024 Maio | 132 | 75 | 207 |
| 2024 Abril | 138 | 81 | 219 |
| 2024 Março | 99 | 53 | 152 |
| 2024 Fevereiro | 134 | 88 | 222 |
| 2024 Janeiro | 96 | 55 | 151 |
| 2023 Dezembro | 102 | 54 | 156 |
| 2023 Novembro | 108 | 104 | 212 |
| 2023 Outubro | 103 | 84 | 187 |
| 2023 Setembro | 134 | 72 | 206 |
| 2023 Agosto | 96 | 38 | 134 |
| 2023 Julho | 126 | 36 | 162 |
| 2023 Junho | 97 | 42 | 139 |
| 2023 Maio | 92 | 23 | 115 |
| 2023 Abril | 89 | 41 | 130 |
| 2023 Março | 85 | 54 | 139 |
| 2023 Fevereiro | 72 | 60 | 132 |
| 2023 Janeiro | 105 | 75 | 180 |
| 2022 Dezembro | 64 | 38 | 102 |
| 2022 Novembro | 53 | 55 | 108 |
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