Is there a link between cholesterol-lowering medications and atopic dermatitis?

Effect of CLMs on AD is biologically plausible but clinically unproven. Signals of concern are most consistent for 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase and Niemann-Pick C1-Like 1 (NPC1L1) inhibition, whereas Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition appears protective in some populations. Current studies are limited by confounding, heterogeneous outcomes and sparse ancestry-specific analyses. Until robust causal and pharmacoepidemiologic studies across ancestries are available, clinicians should prioritize established cardiovascular benefit of lipid reduction while monitoring for new or worsening dermatitis after therapy initiation. Future work should triangulate Mendelian randomization with pharmacoepidemiology designs in large, diverse datasets to deliver definitive guidance.