Lithium and skin: dermatologic manifestations of lithium therapy

Jafferany, Mohammad

doi:10.1111/j.1365-4632.2008.03873.x

Cited by 32 publications

(27 citation statements)

References 148 publications

(229 reference statements)

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“…Not all patients on lithium treatment will develop exacerbation. Therefore, pre-existing psoriasis is not considered a contraindication to lithium treatment (for a full review of this literature, see [36]). …”

Section: Psoriasismentioning

confidence: 99%

“…Patients with psoriasis have high levels of anxiety, depression, worry and suicidal ideations compared with normal controls [35]. There is another concern for psychiatrists related to lithium-induced psoriasis that may occur in the early years of treatment [36]. Lithium has been implicated in the induction and exacerbation of psoriasis within a few weeks to a few months of initiating lithium therapy.…”

Section: Psoriasismentioning

confidence: 99%

“…Younger patients have a higher incidence of hair loss and curling [89]. Lithium is associated with psoriasis, acne, skin rash and urticaria [4,36]. Antipsychotics can cause photosensitivity (e.g., phenothiazines) and changes in pigmentation (e.g., thioridazine and chlorpromazine) [4].…”

Section: Dermatologic Side Effects Of Psychotropic Medicationsmentioning

confidence: 99%

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The psychiatric aspects of skin disorders

Osman¹,

Mufaddel²,

Mugaddam

et al. 2011

Expert Review of Dermatology

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The skin is recognized as an important mode of communication between the external and the internal psychic and biological processes [1]. The skin and the psyche are closely related from historical, embryologic, biological, psychological developmental and cultural perspectives.The importance of the skin is that it is literally the initial point of contact between the external and internal environments. Exposure to external pollutants, toxins, allergens and other noxious environmental elements find symptomatic expression through the skin.Embryologically, the shared origins of brain and skin are well recognized. Both are developed from the same embryologic germ layer (ectoderm) and two-way communication influences seem to persist throughout the life cycle.Biologically, the contribution of stress to skin diseases is backed by neuroendocrine and immunologic sciences. Emotional factors influence many skin diseases, and the correlation between stressful life events and disease flares is well-recognized in dermatology [2]. Flares of psoriasis, herpes simplex and atopic eczema are influ enced by proinflammatory cytokines, which are also modulated by psychosocial stressors [3]. The cytokines regulate immunologic responses and also mediate inflammatory processes, with recurrent hormonal secretion leading to central biologic changes in mood, anxiety and vegetative conditions [4].Psychologically, the internal psychological factors and emotional suffer ing may eventually find the skin a suitable organ for a visible expression of turmoil. This close relationship between the skin and the psyche has long been recognized in the sci entific literature. On 7 July 1949, AW Watt read an article at the 25th annual meeting of the British Association for Dermatology and Syphilology in London (UK) in which he encouraged dermatologists to consider psycho logical factors related to dematologic conditions [201].In addition to Watt, there were many proponents of the concept of intercon nection between the skin and the psyche with proposed modelsThe skin and the psyche are linked from embryologic, biological, psychological and cultural perspectives. Both the skin and the brain are developed from the same ectodermic germ layer. New evidence in psychoneuroimmunology suggest that both the skin and the psyche are affected by immunologic vulnerabilities and endocrine reactions. Emotional stress may exacerbate many chronic dermatoses and can initiate a vicious cycle referred to as the 'itch-scratch cycle'; therefore, treatment of such cases may be difficult without addressing stress. The dynamic interaction between the skin and the psyche is also manifest in cosmetic behavior, whereby the psychological state of the individual is altered through the widely utilized cosmetics and cosmetic procedures. The motives for seeking cosmetic procedures may include a desire to enhance selfconfidence, body image and self-empowerment. Individuals of both genders are becoming concerned about their physical appearance and are increasingly seeking cosmetic procedure...

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Section: Psoriasismentioning

confidence: 99%

Section: Psoriasismentioning

confidence: 99%

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The psychiatric aspects of skin disorders

Osman¹,

Mufaddel²,

Mugaddam

et al. 2011

Expert Review of Dermatology

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“…Most interestingly, lithium-mediated inhibition of GSK-3 was recently shown to result in increased neutrophil production and release of lysosomal enzymes (19). This effect has been linked with several cutaneous side effects of lithium therapy [reviewed in (20)] and might well account for the development of UD lesions, a prominent hallmark of which is a massive neutrophil infiltration.…”

Section: Discussionmentioning

confidence: 99%

Experimental analysis of risk factors for ulcerative dermatitis in mice

Neuhaus

Niessen

Mesaros

et al. 2012

Experimental Dermatology

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Ulcerative dermatitis (UD) is a severe inflammatory skin disorder with an unknown aetiology. Recently, insulin receptor substrate 1 KO mice were shown to be fully resistant to UD. In this study, we showed that high-fat diet (HFD) feeding significantly increased incidence of UD in wild type (WT) C57BL/6 mice, as did lithium-mediated inhibition of GSK3-b, which is a key negative regulator of IRS1. In contrast to WT mice, resistance to UD was fully preserved in HFD-fed Irs1-KO mice. Our results identify IRS1 as a key determinant of UD pathogenesis and establish a direct link between diet composition, obesity-induced inflammation and chronic ulceration.

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“…Although quantitative meta-analytical estimates did not show an increased rate of skin disorders in lithium-treated patients compared to those given placebo (McKnight et al 2012), there is substantial anecdotic evidence supporting this association. Indeed, some authors indicated that the rate of cutaneous adverse reactions during lithium maintenance therapy might be as high as 45% (Jafferany 2008). Here, firstly we presented a new case of adverse cutaneous reaction during lithium treatment, confirmed by a re-challenge of the drug after its discontinuation.…”

Section: Introductionmentioning

confidence: 99%

Cutaneous adverse reaction during lithium treatment: a case report and updated systematic review with meta-analysis

Pinna

Manchia

Puddu³

et al. 2017

Int J Bipolar Disord

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ObjectivesTo present a new case of adverse cutaneous reaction during lithium treatment and to update the systematic review and meta-analysis of the incidence of this adverse reaction.MethodsWe conducted a systematic search (performed in September 2016) for peer-reviewed articles in English indexed in Medline (2011-present). Meta-analytical estimates were obtained using the “Metafor” package.Case presentationMs. H., a 31-year-old Caucasian woman with BD1, was admitted to the inpatient unit for a full-blown psychotic episode and treated with carbamazepine 400 mg q.d., lithium carbonate 450 mg q.d., and risperidone 4 mg q.d. with clinical improvement. After 12 days from the start of psychopharmacological treatment, she manifested a cutaneous reaction that motivated the stop of carbamazepine treatment, as well as the increase in lithium carbonate dose (750 mg q.d.). Risperidone dose remained unvaried. Since the skin lesion persisted after 8 days from withdrawal of carbamazepine, the private practitioner stopped also lithium carbonate treatment (de-challenge), maintaining risperidone treatment. The cutaneous reaction resolved spontaneously after six days from withdrawal of lithium carbonate. Subsequently, the worsening of psychopathological conditions motivated a new admission during which lithium carbonate was reintroduced (16 days after its suspension) (re-challenge). On the following day, we observed an itching erythematous maculopapular rash involving the trunk, the four limbs, and the oral mucosa.ConclusionsOur case of an erythematous maculopapular rash during lithium treatment was the first to present a challenge–de-challenge–re-challenge sequence that suggests causality. Although meta-analysis does not point to an increased rate of adverse skin reaction during lithium treatment, clinicians should not neglect to monitor cutaneous symptoms during lithium treatment.

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Lithium and skin: dermatologic manifestations of lithium therapy

Cited by 32 publications

References 148 publications

The psychiatric aspects of skin disorders

The psychiatric aspects of skin disorders

Experimental analysis of risk factors for ulcerative dermatitis in mice

Cutaneous adverse reaction during lithium treatment: a case report and updated systematic review with meta-analysis

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