Efficacy and safety of topical statins for porokeratosis: a systematic review and practice-guided synthesis.

Background: Porokeratosis comprises keratinization disorders with 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. Objectives: To consolidate fragmented data into a pragmatic framework for clinicians and to highlight priorities for future controlled trails. Methods: We performed a PRISMA-based systematic review of PubMed, Embase, Scopus and ClinicalTrials.gov to 8 December 2025, including all study designs that reported patient-level outcomes with topical statins. Results: Thirty-three studies involving 162 patients met the inclusion criteria: three small, randomized trials and predominantly case series and case reports. In nonrandomized studies with analysable data ( Conclusions: Overall, 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.