Skin Rashes with Mood Stabilizers

Skin Rashes with Mood Stabilizers



(1) Acne:

    • Onset: first 6 months of treatment.


    • Mechanism: Lithium included increase in circulating neutrophil chemotaxis, stimulating lysosomal enzyme release, and induce follicular hyperkeratosis. Common Presentation: monomorphic, papulopustular eruption of the trunk and extremities.


  • Treatment: Antibiotics; Benzoyl Peroxide; Tretinoin. (Source: 1)

(2) Psoriasis:

    • Onset: ranges from a few weeks to several months.


    • Mechanism: Lithium induced decrease in cAMP & Inositol lowers intracellular calcium, resulting in lack of differentiation & increased proliferation of keratinocytes, enhanced chemotaxis and leukocytes phagocytic activity.


  • Common Presentation: typical plaque type lesions affecting knees, elbows & scalp.
    Treatment: topical corticosteroids, topical retinoids, UV light. (Source: 2)


(1) Morbiliform Rash: Benign and common.

    • Onset: 2-8 weeks after initiation of medication.


    • Risk: Higher dose; Rapid titration; lamotrigine and valproate coadministration.


    • Presentation: Measles like appearance.


  • Treatment: Disconinue medications (rash resolve 1-2 weeks after discontinuation); antihistamines. (Source: 3)

(2) Stevens-Johnson Syndrome: Rare dermatologic emergency.

    • Onset: 1-3 weeks after initiation of medication.


    • Presentation: small blisters on purpuric macules, producing target lesions. Associated with fever, sore throat, chills, and malaise and corneal scarring.


    • Mechanism: immune-complex-mediated hypersensitivity reaction.


  • Treatment: Discontinue medication; Supportive systemic steroids; infection control & associated skin care. (Source: 4)




  1. Am J Clin Dermatol 2004;5:3-8.;
  2. Br J Dermatol 1983; 109 (1);9-13.;
  3. Epilepsia 1999; 40:985-991.;
  4. N Engl J Med. 1994;331:1272-1285.

Please do post your questions or comments below. 

Dr. Harvinder Singh, M.D. (Admin)

Enroll in our online course to have access to all important clinically relevant psychiatry topics in one place.

Related Articles