Lithium psoriasis with

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). 

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... 

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A 42-year-old woman taking lithium developed psoriasis which resolved when the drug was withdrawn (419).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). 

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. 

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... 

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. 

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