Efficacy and Safety of Topical Statin Therapy for Porokeratosis: A Systematic Review and Meta‐Analysis

Background and Objective Porokeratosis comprises a heterogeneous group of keratinization disorders with malignant transformation potential. While multiple therapeutic options exist, clinical outcomes remain suboptimal. Emerging evidence suggests promising efficacy of topical statin therapy, though systematic evaluation is currently lacking. We conducted this systematic review and meta‐analysis to investigate the efficacy and safety of topical statin therapy for porokeratosis and attempt to clarify the therapeutic mechanism. Methods A comprehensive search of topical statin therapy for porokeratosis from PubMed, Embase, Web of Science, and Cochrane Library databases from the database inception to June 21, 2025, was conducted. A total of 37 studies were identified for systematic review, including RCTs ( n = 3), cohort study ( n = 1), case reports, and case series ( n = 33). The 3 RCTs were quantified and analyzed for meta‐analysis. A fixed‐effects model was performed for meta‐analysis. I 2 was used to assess heterogeneity of studies. The study protocol is registered with PROSPERO, number CRD420251078561. Results In this systematic review and meta‐analysis that included 37 articles and 152 participants, the pooled overall response rate to topical statin was 88.5% across all porokeratosis subtypes. In subtype analysis, the pooled overall response rate achieved 87.8% in disseminated superficial actinic porokeratosis, 81.3% in linear porokeratosis, and 90.0% in porokeratosis ptychotropica. In subgroup analysis, the response rates of topical statin‐only therapy without cholesterol and statin–cholesterol combination therapy were 91.4% and 85.5%, respectively, showing no statistically significant difference ( p = 0.52). The most frequently reported adverse events were erythema/rash (9.0%), pruritus (7.5%), application site discomfort (3.0%), and allergic contact dermatitis (ACD; 1.5%); notably, simvastatin‐induced ACD was confirmed by patch testing in 2 reported cases. Conclusion Topical statin therapy is an effective treatment option for all porokeratosis subtypes with great tolerance. No significant difference in the therapeutic effect of topical statin and statin–cholesterol substantiates the accumulation of toxic intermediate metabolites as the potential predominant pathogenic mechanism.