Psoriasis sufferers have an increased risk of cardiovascular disease, according to evidence from recent analyses of patient records. This has led some to consider using statins for psoriasis relief but is there any evidence of benefit? Indeed, do some statins makes psoriasis worse, or even trigger the skin condition?
Statins have a number of effects on the skin and are capable of triggering autoimmune diseases such as systemic lupus erythematosus, dermatomyositis, polymyositis, lichen planus pemphigoides, and, it seems, psoriasis vulgaris (Cozzani et al., 2011). There are numerous drugs that can cause psoriasis or trigger psoriasis flare-ups, including:
- Synthetic antimalarials
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Some anti-hypertensive drugs
- Beta-adrenergic antagonists
- Tumour necrosis factor-alpha inhibitors.
Many people who experience psoriasis for the first time in their forties and fifties may be able to trace the skin disease back to blood pressure medications that are frequently prescribed in such an age-group. Using natural anti-hypertensives may allow them to lower blood pressure without compromising skin health.
Evidence Statins Improve Psoriasis Symptoms
Despite these connections between psoriasis severity and a number of medications, there have been a couple of recent journal articles suggesting that patients taking statins actually see improvements in symptoms of the skin condition. One such study was an analysis of 232 patients with psoriasis (Perry et al., 2010).
Their medical records showed symptom severity (based on the degree of body surface area covered with lesions) at the time a new psoriasis medication was started and symptom severity at their most recent physician visit. A statin was given to 66 of the patients, with the remaining 166 patients acting as a control. The psoriasis therapies used included topical corticosteroids, topical vitamin D, and some ischemic treatments.
Patients in both the statin and the non-statin groups saw a decrease in symptoms during the study, with initial BSA scores of 13.26% and 12.25%, respectively, going down to 5.21% and 7.43% after medication.
The statin group had an overall reduction in psoriasis severity of 64%, and the non-statin group had a 45% reduction. There are a number of issues with this study, however, including the lack of double blind conditions, no proper control group where no changes in medication were made, and the small number of patients taking the statin medications.
The range of psoriasis therapies used also clouds the data as disease reduction scores could have been significantly higher or lower with just one of the listed protocols.
No Significant Benefit Over Placebo for Atorvastatin in Psoriasis
In another small study which was placebo-controlled researchers found no significant difference in the benefits of statins for psoriasis than placebo (Faghihi et al., 2011). A 40mg/d atorvastatin was used in the study, with patients in both the placebo and treatment group continuing to use topical treatments for the 12 weeks of the study period.
All patients had baseline BSA scores over 10% and 40 of the 42 patients enrolled completed the study. Patients were aged 16-60 years old and there was significant improvement in the 20 patients on placebo as well as the 20 patients on the statin; 8 of the statin patients and 7 of the placebo patients had a reported 75% improvement in symptoms. The researchers suggest that a higher dose of the statin may yield more significant benefits for psoriasis patients and that more studies were warranted.
Atorvastatin Triggers Psoriasis
Interestingly, the statin used to treat psoriasis in this study was found to actually worsen psoriasis in one case report from Cozzani, et al. The case detailed a 47 year old man who had no family history of psoriasis, who was taking Ca-antagonists and ACE-inhibitors for blood pressure control, and whose moderate psoriasis vulgaris worsened three months after beginning to take atorvastatin. When he stopped taking the statin his psoriasis improved.
The man had erythematous-scaling infiltrated plaques of psoriasis with regular margins on his torso and arms and the familiar scaly lesions on the palms of his hands and the soles of his feet. To control his high cholesterol he was prescribed a 20mg/d statin, only to present with severe psoriatic lesions on his arms that were pruritic (itchy), new lesions on his legs, and worse onychopathy (psoriasis in the nails). The atorvastatin was ceased and replaced with rosuvastatin. Two months later, the man’s lesions had improved.
How Statins Could Help Psoriasis
In another study on statins and psoriasis, researcher found that some, but not all, statins have a range of potentially beneficial effects on skin disease through inhibition of factors that increase lesion formation (Kim et al., 2011). In psoriasis, there is increased expression of lesional CCL20 which is further increased by interleukin-1beta, tumor necrosis factor-alpha, and interleukin-17A.
Kim, et al, found that fluvastatin and simvastatin, but not pravastatin, inhibited the increase of CCL20 by these immune system factors and could, therefore, offer a mechanism by which statins help reduce psoriasis severity.
Why Some Statins Trigger Psoriasis
The mechanism behind atorvastatin’s effect on psoriasis is not fully known. However, the statin does affect singlet oxygen formation (free radicals) and lead to photobiological damage and it may be that statins also activate STAT3, which is a molecule that can disrupt the normal turnover rate of skin cells.
STAT3 delivers antiapoptotic signals to epidermal keratinocytes, essentially telling skin cells to stick around after they would ordinarily have died and been shed. This can lead to the recognisable scales of psoriasis as unhealthy cells pile up.
What Can Psoriasis Patients Do?
Patients whose psoriasis worsens over a short period of time are encouraged to talk to their physician about their history of use of medications, prescribed or otherwise. It may be that a pharmacologic effect is able to be found that can allow for symptom improvement with a change in medication or therapeutic approach.
Natural psoriasis remedies may be helpful to soothe symptoms whilst finding a non-medicated remedy to high cholesterol, such as improvements in diet and lifestyle. As many patients do not report flare-ups of psoriasis to their physician, and many physicians remain unaware of the potential for statins to exacerbate psoriasis, the available information on the number of people experiencing this adverse effect of statins is scarce.
Kim, T.G., Byamba, D., Wu, W.H., Lee, M.G., Statins inhibit chemotactic interaction between CCL20 and CCR6 in vitro: possible relevance to psoriasis treatment. Exp Dermatol. 2011 Oct;20(10):855-7. https://www.ncbi.nlm.nih.gov/pubmed/21824198
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Cozzani, E., Scaparro, M., Parodi, A., A case of psoriasis worsened by atorvastatin, J Dermatol Case Rep. 2009 December 30; 3(4): 60–61. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3163346/
Perry, A., Chen, S., American Academy of Dermatology (AAD) 68th Annual Meeting: Abstract P3309. Presented March 7, 2010.
Faghihi, T., Radfar, M., Mehrabian, Z., Ehsani, A.H., Rezaei Hemami, M., Atorvastatin for the treatment of plaque-type psoriasis. Pharmacotherapy. 2011 Nov;31(11):1045-50. https://www.ncbi.nlm.nih.gov/pubmed/22026392