P173 Topical statins for porokeratosis: targeting the mevalonate pathway – a systematic review and evidence map

Abstract

Porokeratosis comprises keratinization disorders, which have few consistently effective, nondestructive treatments. Topical inhibition of the mevalonate pathway with statins is biologically plausible, but the clinical evidence is scattered across small reports. Our aim was to systematically synthesize clinical evidence on the efficacy and safety of topical statins for porokeratosis by subtype, and to evaluate whether adding cholesterol offers incremental benefit over statin monotherapy. We performed a PRISMA-based systematic review of PubMed, Embase, Scopus and ClinicalTrials.gov to 7 December 2025, including all study designs that reported patient-level outcomes with topical statins. Thirty-three studies involving a total of 162 patients met the inclusion criteria: three small randomized trials and predominantly case series and reports. In nonrandomized studies with analysable data (98 patients), most patients achieved partial improvement (68%), whereas complete or near-complete clearance was less frequent (16%). Disseminated superficial actinic porokeratosis (DSAP) appeared most responsive. Randomized evidence showed clinical improvement with topical statins but did not support routine addition of cholesterol to statin formulations. Topical statins were generally well tolerated, with several patch-test-confirmed cases of simvastatin allergic contact dermatitis but no serious systemic adverse events. Certainty of evidence (GRADE) was low for DSAP improvement and serious harms, and very low for other subtypes, reflecting small sample sizes, risk of bias and heterogeneity. Topical statin monotherapy emerges as a mechanism-based, field-directed option for porokeratosis, particularly DSAP, most often yielding partial – rather than complete – clearance, with a favourable safety signal. This review consolidates fragmented data into a pragmatic framework for clinicians and highlights priorities for future controlled trials.