Department of Dermatology and Rheumatology, Palo Alto Medical Foundation Group, Palo Alto, CA, USA.
J Cutan Med Surg. 2010 Sep-Oct;14(5):207-11. doi: 10.2310/7750.2010.09042.
The statin medications for lowering of blood cholesterol can be associated with cutaneous lichenoid reactions but also a variety of other adverse cutaneous eruptions, including Stevens-Johnson syndrome, toxic epidermolytic necrolysis, porphyria cutanea tarda, linear IgA bullous dermatosis, and reaction patterns (lupus and dermatomyositis-like and pustular). Cutaneous eruptions ("eczema" in the product literature) owing to simvastatin are reported in approximately 1.5% individuals compared with placebo.
To correlate the clinical and microscopic features of an unusual vesiculobullous reaction to simvastatin.
Retrospective analysis of clinical information and skin biopsies.
We present the case of a 70-year-old man with chronic vesiculobullous and pustular annular lesions on distal arms, legs, hands, and feet for 2 years. The eruption was recalcitrant to potent topical corticosteroids. Multiple biopsies at different times showed a spongiotic and lichenoid hypersensitivity reaction resembling contact dermatitis, purpuric drug eruption, and pustular folliculitis. The common themes in the histopathology were spongiosis with microvesiculation, focal lichenoid infiltrates, dermal hemorrhage, and chronic superficial inflammatory cell infiltrates with eosinophils. The eruption began when simvastatin was started, improved when it was stopped, recurred with rechallenge, and cleared when simvastatin was discontinued.
Acral cutaneous vesiculobullous eruption is an uncommon adverse drug eruption due to simvastatin, one of many different patterns possible. A high level of suspicion for an unexplained cutaneous eruption in an older individual on statins is important to identification of the disorder and discontinuation of the offending medication.
降低血液胆固醇的他汀类药物可能与皮肤苔藓样反应有关，但也可能与其他各种不良皮肤疹有关，包括史蒂文斯-约翰逊综合征、中毒性表皮坏死松解症、迟发性皮肤卟啉症、线性 IgA 大疱性皮病和反应模式（狼疮和皮肌炎样和脓疱性）。与安慰剂相比，约有 1.5%的个体报告因辛伐他汀引起的皮肤疹（产品文献中的“湿疹”）。
分析辛伐他汀引起的一种不寻常的水疱性大疱反应的临床和显微镜特征。
回顾性分析临床资料和皮肤活检。
我们报告了一例 70 岁男性慢性水疱性大疱性和脓疱性环状病变，累及四肢远端、手和脚，持续 2 年。该皮疹对强效局部皮质类固醇有抗药性。不同时间的多次活检显示出类似于接触性皮炎、瘀点性药物疹和脓疱性毛囊炎的海绵状和苔藓样超敏反应。组织病理学的共同主题是海绵形成伴微泡、局灶性苔藓样浸润、真皮出血和慢性浅表性炎症细胞浸润伴嗜酸性粒细胞。皮疹在开始使用辛伐他汀时出现，停药后改善，重新使用时复发，停药后消退。
辛伐他汀引起的四肢皮肤水疱性大疱疹是一种罕见的药物不良反应，可能是许多不同类型之一。对于在他汀类药物治疗的老年个体中出现不明原因的皮肤疹，应高度怀疑该疾病，并停用引起该疾病的药物。
