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.
: (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)
CARBAMAZEPINE & LAMOTRIGINE
: Benign and common. (1) Morbiliform Rash
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.
: Rare dermatologic emergency. (2) Stevens-Johnson Syndrome
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.
Am J Clin Dermatol 2004;5:3-8.;
Br J Dermatol 1983; 109 (1);9-13.;
Epilepsia 1999; 40:985-991.;
N Engl J Med. 1994;331:1272-1285.
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Dr. Harvinder Singh, M.D. (Admin)
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