A Case of Pityriasis Rubra Pilaris Following Atorvastatin Therapy

Abstract

Background: Pityriasis rubra pilaris (PRP) is a rare dermatologic disorder of unknown etiology characterized by distinct red-orange scaly plaques, red follicular papules, and palmoplantar keratoderma. The occurrence of PRP following statin therapy is exceptionally uncommon, with only a few cases reported in the literature.

Case Presentation: An 83-year-old male developed PRP within one month of initiating atorvastatin therapy. Detailed history revealed no other new medications or identifiable triggers. Initially misdiagnosed with psoriasis, the patient underwent multiple biopsies and several unsuccessful treatment regimens before receiving a clinical diagnosis of PRP. He ultimately responded well to a combination of methotrexate and secukinumab therapy.

Discussion: PRP is often challenging to diagnose due to clinical and histologic overlap with other dermatoses, particularly psoriasis, and is misdiagnosed in a high percentage of cases. Although rare, drug-induced pityriasis rubra pilaris has been reported in association with several medication classes, including tyrosine kinase inhibitors and immunomodulatory agents. The mechanisms behind statin-induced PRP remain speculative; recent insights suggest a possible involvement of the interleukin (IL)-23/T-helper 17 cell (Th17) inflammatory pathway.

Conclusion: This case underscores the diagnostic challenges associated with PRP and proposes a potential association between statin use and PRP onset.