Distressing cutaneous lesion among bipolar affective disorder patients on lithium therapy: A retrospective cross-sectional study

Abstract

Aim:To assess the incidence of cutaneous lesion in bipolar affective disorder (BPAD) patients on lithium therapy. To evaluate the relationship between duration of lithium therapy, dosage of lithium, serum lithium level, and cutaneous lesions. To assess whether reduction/stoppage of dose of lithium has any change in the course of cutaneous side effects. To look for a relationship between addition of isotretinoin and the course of mood disorder.Methodology:We retrospectively collected hospital case records of 125 consecutive BPAD patients initiated lithium therapy, assessed with inclusion and exclusion criteria. We follow up them for 2½ years for the assessment of above said aims.Results:The prevalence of skin reaction in BPAD patients with lithium therapy was 19.8%. Among patients on lithium therapy, cutaneous lesion emerged in initial 6 months and later after 1 year of treatment. Nearly 55% of patients on higher doses of lithium (1200 mg) had a cutaneous lesion. Patient on therapeutic serum level of lithium had a higher incidence of skin lesion. Out of six patients in whom dosage of lithium was reduced, three of them had reduced lesions (P = 0.6), in two patients, skin lesion increased, and one patient had no change. Among 11 patients treated with isotretinoin, only two patients had emergence of depressive symptoms.Conclusion:Lithium continues to increase the incidence of multiple cutaneous lesions among BPAD patients on lithium therapy. Incidence of cutaneous side effects directly correlates with the dose of lithium and therapeutic range of serum lithium level. Altering the dose of lithium does not statistically influence the cutaneous lesion.

A perspective study of cutaneous manifestations in primary psychiatric disorders in a tertiary care hospital

“…These effects correlate directly with the dose of lithium and therapeutic range of serum lithium. [ 10 ]…”

Dermatological Morbidity in Patients With Primary Psychiatric Conditions

“…6 Prevalence of our study was similar to a study conducted in India where 77% of psychiatric patients showed dermatological disorders. 7 This study concluded that out of psychiatric patients having dermatological diseases, a majority 62% were females and 38% were males. This also bore resemblance to studies conducted in Cairo, Egypt where the majority 61% were females, 1 in India 58.1% 4 and in contrast to a study conducted in Lahore where female psychiatric patients having dermatological diseases were only 39.4%.…”

A Rare Phenomenon of Lithium-Associated Acne Inversa: A Case Series and Literature Review

“…The chemical lithium, which psychiatrists prescribe to treat bipolar affective disorders, has the highest rate of cutaneous side effects of any psychoactive substance [1]. The most frequent cutaneous responses to lithium include acneiform eruptions, psoriasis, maculopapular eruptions, and follicular eruptions [2][3][4]. The exact mechanism by which lithium causes these reactions is yet not known.…”

“…However, safety concerns throughout the treatment remain significant due to its narrow therapeutic window and major side effects like hypothyroidism and cardiac and renal dysfunction; thus, it requires monitoring. Common side effects include gastrointestinal symptoms like nausea, diarrhea, urinary system problems like increased urinary frequency, and excessive thirst [ 4 ]. Weight gain and impaired cognition tend to be more stressful to the patients and may contribute to poor medication adherence [ 5 ].…”