Skin Rashes with Mood Stabilizers

Skin Rashes with Mood Stabilizers

 

LITHIUM

(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)

CARBAMAZEPINE & LAMOTRIGINE

(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)

 

 

Source:

  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.

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Dr. Harvinder Singh, M.D. (Admin)


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