Psoriasis lithium

Other late-appearing lithium side effects include benign reversible leukocytosis, acne, alopecia, exacerbation of psoriasis, pruritic dermatitis, mac-ulopapular rash, folliculitis, and weight gain. 

Dermatological reactions to lithium include acne, follicular eruptions, and psoriasis. Hair loss and thinning also have been reported. Except for cases of exacerbation of psoriasis, these reactions are usually benign and may not warrant discontinuation of lithium treatment. Lithium-induced acne responds to topical treatment with retinoid acid, such as tretinoin (Retin-A). 

Lithium Neurological tremor, ataxia, seizures Endocrine hypothyroidism Cardiovascular T wave changes, sinus node dysfunction Renal polyuria, nephrogenic diabetic insipidus Dermatological hair loss, acne, psoriasis, rash Gastrointestinal nausea, diarrhea Miscellaneous fluid retention, weight gain, weakness... 

Medical problems, such as psoriasis, preclude the use of lithium. 

Early in the course of lithium therapy, exacerbations of psoriasis and acneiform eruptions as well as other skin reactions may occur. Possible mechanisms have included lithium s ability to decrease cAMP as well as to increase the number and activity of polymorphonuclear leukocytes. Those with a predisposition to skin disorders are most at risk for this complication, with women more likely than men to experience a dermatological reaction to lithium. These problems may clear spontaneously or may require lithium dose reduction, appropriate dermatological intervention, or lithium discontinuation ( 77). 

Notes Drugs associated with the exacerbation of psoriasis include lithium, beta-adrenergic receptor blocking agents and antimalarials. Withdrawal of corticosteroid therapy may activate pustular psoriasis. NSAIDs, such as ibuprofen... 

Trazodone has caused generalized erythematous maculo-papular eruptions (24), erythema multiforme (although the patient was also taking lithium) (25), and generalized pustular psoriasis in a patient who had had stable plaque psoriasis for 19 years (26). 

The cutaneous adverse effects of lithium have been reviewed (401,402). Lithium can cause aggravation of psoriasis. Other dermatological problems related to lithium treatment include acne, folliculitis, and maculo-papular eruptions. The prevalence of dermatological difficulties is up to 45%, although many have reported a much lower rate, less than 4%. Men are more susceptible to than women. Most patients can be managed without withdrawing lithium, but aggravation of psoriasis may make it necessary. 

Acne can occur or worsen during lithium treatment (411). In a comparison of 51 patients taking lithium with 57 patients taking other psychotropic drugs, there were secondary skin reactions in 45% of the former and 25 of the latter while acne (33 versus 9%) and psoriasis (6 versus 0%)... 

A 42-year-old woman taking lithium developed psoriasis which resolved when the drug was withdrawn (419). Brief mention was made of two patients (age and sex unstated) taking lithium whose psoriasis improved with oral omega-3 fatty acids (420). 

Lithium worsened psoriasis in a 54-year-old woman improvement followed withdrawal (421). 

Lozano Garcia MC, Baca Garcia E. Psoriasis y tratamento conlitio un mecanismo fisiopatologico commun . [Psoriasis and lithium treatment a common pathophysiology .] Actas Esp Psiquiatr 2002 30(6) 400-3. 

Akkerhuis GW, Nolen WA. Lithium-associated psoriasis and omega-3 fatty acids two case reports. Bipolar Disord 2002 4 117. 

Miyagawa M, Shimoda K, Danno K, Kato N. Exacerbation of psoriasis during lithium treatment in a patient with bipolar I disorder. Int Chn Psychopharmacol 2000 15 368. 

Psoriasis and lithium treatment a common pathophysiology ) Actas Esp Psiquiatr 2002 30(6) 400-3. 

Drugs that can precipitate psoriasis are, among others, beta-blockers and lithium. Drugs that are reported to aggravate psoriasis are antimalarials, beta-blockers, lithium, NSAIDs, quinidine, and photosensitizing drugs. The effect and extent of these drug-induced psoriatic eruptions are dose-dependent. 

Sometimes psoriasis can occur in response to drugs such as lithium (Chapter 11), chloroquine and NSAIDs (Chapter 7), beta-blockers and ACE inhibitors (Chapter 4). 

Psoriasis is an inflammatory skin disease characterized by red, scaly, raised plaques. Usually, the psoriasis lesions are several centimeters in diameter and separated by normal-appearing skin [239, 240]. Psoriasis involves a chronic cutaneous pathologic process, driven by interactions between infiltrating leukocytes (Tcells, dendritic cells, macrophages, neutrophils), cytokines, chemokines and keratinocytes, the cells from the epidermis. The disease is initiated or exacerbated by infections, physical and/or emotional stress, antigenic stimuli and various medications (e.g., lithium, P-block-ers [241, 243]). Psoriatic plaques can revert back to symptomless skin spontaneously or after treatment vdth selective immune-targeted agents [239, 240, 242-244]. 

Skin Psoriasis Determination of the relative risk of psoriasis as a function of psychotropic medication has been studied in the UK General Practice Research Database [54 ], in which 36 702 cases of psoriasis were identified and the same number of matched controls. Use of psychotropic drugs was determined by current and four previous prescriptions. Long-term lithium... 

Brauchli YB, lick SS, Curtin F, Meier CR. Lithium, antipsychotics, and risk of psoriasis. J Clin Psychopharmacol 2009 29(2) 134-40. 

Skin Lithium is associated with an increased risk of psoriasis [76, 77 ]. In a 10-year database study using the UK-based General Practice Research Database (GPRD) 36 702 subjects with psoriasis were compared with an equivalent matched group without psoriasis long-term use of lithium (five or more prescriptions) was... 

Jafferany M. Lithium and psoriasis what primary care and family physicians should know. Primary Care Companion. J Clin Psychiatry 2008 10(6) 435-9. 

Psoriasis is a severely debilitating skin disease which affects 2% of the population world-wide. It is responsible for more days spent in hospital than any other skin complaint and present treatments are rudimentary and rather unsatisfactory. Characteristically there is an impairment of normal cell differentiation and development, excessively high levels of some arachidonate-metabolites and a potentiation of the symptoms in patients with lithium therapy. The symptoms have been drawn together recently with the suggestion that defective phosphoinositide metabolism (section 8.8) is involved. 

---