A control study of the cutaneous side effects of chronic lithium therapy

Chan, Henry H.; Wing, Yun Kwok; Su, R. Yuxiong; Krevel, Charlotte Van; Lee, Paul

doi:10.1016/s0165-0327(99)00064-6

Cited by 76 publications

(46 citation statements)

References 14 publications

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“…In the present case, we suggest discontinuation when adverse effect appear, and close follow up in patients being prescribed lithium for the first time in order to prevent lithium toxicity, and adverse effects in initial and maintenance stages. 1,3 …”

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confidence: 99%

Reversible skin rash in a bipolar disorder patient on first use of lithium

Wang¹,

Yang²

2013

Psychiatry Clin Neurosci

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that the depressive symptoms remitted rapidly after discontinuation of entecavir, we believe that the exacerbation of depression was secondary to the use of entecavir. Moreover, entecavir is not a substrate, inhibitor, or inducer of the cytochrome P450 enzyme system; 2 the possibility of pharmacokinetic interactions with escitalopram and lorazepam are low and are not expected to exacerbate depression in this case. L ITHIUM IS A traditional medication for bipolar disorders, and known for its multiple adverse effects. Early detection of lithium-related cutaneous side-effects can prevent further injuries. We report a case of whole body maculopapular rash after starting lithium. REFERENCESThe patient was a 37-year-old Han woman admitted to the acute psychiatric ward due to full-blown manic symptoms with psychotic features for 1 month. The patient was diagnosed with bipolar I disorder at 19 years old, and treated in an outpatient clinic with sulpiride 400 mg daily. One month prior to her current admission, the patient started to have delusions of persecution, irritability, pressured speech, buying sprees, disturbing behaviors at work, flight of ideas and insomnia. Hospitalization was therefore arranged to manage her symptoms.On admission, sulpiride 600 mg and lithium 900 mg daily were prescribed. Due to aggravated delusional thinking and aggressive behavior, sulpiride was replaced with risperidone 8 mg per day. The patient responded well to lithium with risperidone, and her mood gradually stabilized. On the seventh day of lithium use, however, the patient was noted to have non-itching, erythematous, maculopapular rash over 70% of total body surface area (TBSA), including face, trunk and four limbs. No evidence of Steven-Johnson syndrome or toxic epidermal necrolysis was noticed. Neither was the patient noted to have any drug allergies or exposure to any allergen. White blood cell count was 6800/mm 3 and serum lithium level was 0.92mEq/L, which were within the therapeutic range. Hydroxyzine 25 mg and chlorampheniramine 4 mg were given, but after 12 h the condition remained the same. All medications were therefore discontinued. In the following 36 h, the skin rash affected only 30% TBSA, and by 72 h it had completely resolved. The patient's manic symptoms were remitted and maintained on monotherapy with risperidone 6 mg.Cutaneous manifestation is reported in 3.4-45% of patients on lithium in the maintenance phase.1,2 The mechanism is considered to be type IV hypersensitivity and associated with decreased cAMP, increased production of neutrophils and keratinocyte proliferation; 1 but lithium is an element found in nature, and drug-related skin eruptions are possibly a reaction to an excipient rather than the lithium itself.Female patients are more likely to report lithiumassociated skin changes and this implies that male patients are not only susceptible to lithium-related skin adverse effects, but also less likely to report.3 Individualized prevalence of lithium-induced skin findings suggests the genetic diversity of h...

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Reversible skin rash in a bipolar disorder patient on first use of lithium

Wang¹,

Yang²

2013

Psychiatry Clin Neurosci

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“…At therapeutic doses, nausea, diarrhea, weight gain, fine tremor of the hands, and skin lesions, especially acne and psoriasis, may happen (9). The major toxic effects related to the use of lithium are the cognitive disturbances, dysarthria, and impaired coordination.…”

Section: Pharmacological Aspectsmentioning

confidence: 99%

Endocrine disturbances related to the use of lithium

Giusti

Amorim

Guerra

et al. 2012

Arq Bras Endocrinol Metab

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SUMMARYDespite recent advances in pharmacological treatment of psychiatric disorders, lithium salts remain frequently used, as they are effective and inexpensive alternatives, especially in the treatment of bipolar disorders. Their use is commonly associated with various endocrine disorders, mainly in thyroid and parathyroid function, and in mineral metabolism. This article aims at reviewing these potential endocrinopathies related to the use of lithium to make health care professionals aware and familiar with these possible complications when they follow up patients using this drug, and to make them able to monitor, identify and institute early and appropriate treatment. SUMÁRIOApesar dos recentes avanços farmacológicos no tratamento dos transtornos psiquiátricos, os sais de lítio permanecem como uma alternativa eficaz e de menor custo, sendo usados com frequência principalmente no tratamento dos transtornos bipolares. O seu uso é comumente relacionado com diversas alterações endocrinológicas, principalmente nas funções tiroidiana, paratiroidiana e do metabolismo iônico. Este artigo tem por objetivo fazer uma revisão dessas potenciais endocrinopatias relacionadas ao uso do lítio, para que, no seguimento de pacientes em uso dessa medicação, os profissionais de saúde estejam atentos e familiarizados com essas possíveis complicações, conseguindo identificar e instituir tratamento precocemente. Arq Bras Endocrinol Metab. 2012;56(3):153-8 Descritores Lítio; hipercalcemia; diabetes insipidus; bócio

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“…Barak taraf›ndan yap›lan ve isotretinoin kullanan 500 askerin dahil edildi¤i çal›fl-mada ise befl askerde "manik psikoz" gözlenmifltir, bu hastalar›n soygeçmifl bilgilerine bak›ld›¤›nda üçünün birinci derece akrabalar›nda bipolar bozukluk tan›s› bulunmufltur 19 . Bipolar tan›s› konmufl ve akne tedavisi için isotretinoin almas› gereken hastalar için di¤er önemli bir sorun da bipolar bozukluk tedavisinde önemli yeri olan lityumun s›k görülen yan etkilerinden birinin akne(%33) olmas›d›r 20 . ‹sotretinoinin neden Çetin ve 4 olabilece¤i psikiyatrik bulgularla ilgili çift kör ve randomize çal›flmalar›n prospektif olarak düzenlenmesinde çeflitli etik sorunlar bulunmaktad›r.…”

Section: ‹Sotretinoinunclassified

Psychiatric Adverse Effects of Dermatological Drugs

Ozmen¹,

Çetin²

2010

turkderm

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A control study of the cutaneous side effects of chronic lithium therapy

Cited by 76 publications

References 14 publications

Reversible skin rash in a bipolar disorder patient on first use of lithium

Reversible skin rash in a bipolar disorder patient on first use of lithium

Endocrine disturbances related to the use of lithium

Psychiatric Adverse Effects of Dermatological Drugs

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