Simvastatin can induce amyopathic dermatomyositis

This paper was published in the British Journal of Dermatology 2009 Jul;161(1):206-8

 

Study title and authors:

Simvastatin-induced amyopathic dermatomyositis.

Inhoff O, Peitsch WK, Paredes BE, Goerdt S, Goebeler M.

 

This paper can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/19438466

 

Dermatomyositis is an inflammatory disease marked by muscle weakness and a distinctive skin rash. Amyopathic dermatomyositis is a variant of dermatomyositis that is characterized by the typical skin rash but without the muscle abnormalities.

 

This paper describes the case of a woman who developed amyopathic dermatomyositis while on statin therapy.

 

(i) A 70 year old woman, treated for several years with simvastatin, sought medical attention for itching, rashes and plaques on sun-exposed parts of her body.

(ii) The patient did not have muscle weakness.

(iii) A skin biopsy revealed dermatitis and lesions coupled with thin and wrinkled skin.

(iv) A diagnosis of simvastatin induced amyopathic dermatomyositis was made.

(v) Simvastatin was discontinued.

(vi) Five months later the skin lesions had almost completely cleared.

Doctor says statin drug hypersensitivity reactions are potentially life-threatening

This paper was published in Chest 1999 Mar;115(3):886-9

Study title and authors:
Polymyalgia, hypersensitivity pneumonitis and other reactions in patients receiving HMG-CoA reductase inhibitors: a report of ten cases.

Liebhaber MI, Wright RS, Gelberg HJ, Dyer Z, Kupperman JL.
Department of Medicine and Pediatrics, UCLA School of Medicine, Los Angeles, CA, USA. mil1258@pol.net

This paper can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/10084510

 
This paper, headed by Dr Myron Liebhaber from the University of California Los Angeles School of Medicine, describes ten patients who developed hypersensitivity-type reactions after taking statin medications. (A hypersensitivity reaction is an exaggerated inflammatory response by the immune system to a drug or other foreign substance).
 
Patient 1
(i) Nine months after starting lovastatin, 20 mg daily, a 54 year old man developed urticaria over his entire body and angioedema of his upper lip. (Urticaria also known as hives, is a kind of skin rash with pale red, raised, itchy bumps. Angioedema is swelling under the skin).
(ii) Tests revealed an autoimmune disorder (where the body attacks its own tissues).
(iii) Lovastatin was discontinued, and his symptoms gradually resolved over seven days. 
 
Patient 2
(i) A 69-year-old woman was referred for medical attention for an evaluation of a cough.
(ii) She had been taking pravastatin, 20 mg to 40 mg daily, for 6 years.
(iii) She was given medication and her condition improved although tests revealed impaired lung function.
(iv) Over the next six weeks her symptoms became much worse and she was given medication.
(v) Despite the treatment her cough continued.
(vi) A scan found inflammation in the lungs.
(vii) A lung biopsy led to a diagnosis of pravastatin induced hypersensitivity pneumonitis. (Hypersensitivity pneumonitis is a disease in which your lungs become inflamed when they are exposed to substances to which you are allergic).
(viii) The pravastatin was stopped, and her cough resolved two weeks later.
(ix) A follow-up scan seven weeks after the first one showed complete resolution of the inflammation in her lungs.

Patient 3
(i) Three years after starting pravastatin 20 mg daily, a 77 year old man developed gradually increasing inflammation, with symptoms of polymyalgia. (Polymyalgia is pain, stiffness and tenderness in many muscles).
(ii) In addition, three years after starting pravastatin, the patient had retinal vein thrombosis. (Retinal vein thrombosis is when one of the tiny retinal veins becomes blocked by a blood clot).
(iii) The patient then developed a sudden worsening of his heart function.
(iv) After discontinuing the pravastatin his heart function normalized, and resolution of the polymyalgia syndrome occurred over one month.

Patient 4
(i) A 66-year-old man started taking lovastatin, 20 mg daily.
(ii) Four years later, the patient complained of fatigability, drowsiness, shortness of breath and joint pain.
(iii) Tests revealed inflammation and an autoimmune disorder.
(iv) He stopped taking lovastatin.
(v) His symptoms gradually resolved over two months.

Patient 5
(i) A 76-year-old woman  was started on lovastatin, 20 mg daily.
(ii) One year later she began to complain of muscle aches.
(iii) Two years later, she developed shortness of breath, joint pain and psoriasis. (Psoriasis is inflammation of the skin and develops as patches of red, scaly skin).
(iv) She then had a small heart attack and a failed artery graft.
(v) Lovastatin was discontinued, and she had a gradual improvement of her shortness of breath, joint pain, muscle pain and back pain over a two month period.

Patient 6
(i) An 80-year-old woman had been taking simvastatin, 10 mg daily, for 3 years.
(ii) She began having shortness of breath on exertion.
(iii) Investigations revealed she had inflammation.
(iv) Simvastatin was discontinued.
(v) Her shortness of breath improved and inflammation decreased over the next three weeks.

Patient 7
(i) A 49-year-old man had been taking pravastatin, 40 mg daily, for four years.
(ii) During this period, he had generalised itching and urticaria, along with swelling of his fingers and feet.
(iii) Test revealed an autoimmune disorder.
(iv) Pravastatin was discontinued, and the itching and swelling gradually resolved over the subsequent month.

Patient 8
(i) A 77-year-old woman was treated with pravastatin, 10 mg daily, for 3 years.
(ii) During this period, she had generalised itching with urticaria.
(iii) Investigations revealed she had inflammation and an autoimmune disorder.
(iv) Her symptoms cleared one month after discontinuing the pravastatin.

Patient 9
(i) A 53 year old man started to take pravastatin 40 mg daily.
(ii) Within six months he developed angioedema (swelling) of the eyelids and a sensation of his airway closing. 
(iii) He discontinued pravastatin.
(iv) His symptoms gradually resolved 30 days later.

Patient 10
(i) A 73-year-old man developed intense itching and urticaria after taking pravastatin 20 mg daily for three years. 
(ii) Tests revealed she had an autoimmune disorder.
(iii) He discontinued pravastatin and 12 days later his symptoms resolved.

Dr Liebhaber concluded: "We feel it is important for clinicians to recognize early symptoms of statin drug hypersensitivity because they are potentially life-threatening".

Statins may be associated with skin lesions

This paper was published in the Journal of Cutaneous Medicine and Surgery 2010 Sep-Oct;14(5):207-11

 

Study title and authors:

Statins and "chameleon-like" cutaneous eruptions: simvastatin-induced acral cutaneous vesiculobullous and pustular eruption in a 70-year-old man.

Adams AE, Bobrove AM, Gilliam AC.

Department of Dermatology and Rheumatology, Palo Alto Medical Foundation Group, Palo Alto, CA, USA.

 

This paper can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/20868617

Adams notes that statins are associated with many types of cutaneous eruptions (skin lesions and rashes) such as Stevens-Johnson syndrome, toxic epidermolytic necrolysis, porphyria cutanea tarda, linear IgA bullous dermatosis, and reaction patterns (lupus and dermatomyositis-like and pustular).

The paper presents the case of a man covered with skin lesions after taking simvastatin (zocor) drugs.

(i) A 70 year old man was prescribed simvastatin and began to suffer with chronic vesiculobullous, see here, and pustular annular lesions, see here, on his arms, legs, hands, and feet.
(ii) After two years the man stopped taking simvastatin and his condition improved.
(iii) He later restarted simvastatin and the lesions recurred.
(iv) He eventually discontinued simvastatin and the lesions cleared.

This case provides evidence that statins may be associated with skin lesions.