Lithium is a medication frequently prescribed for various mood disorders, including bipolar disorder and recurrent unipolar depression. It has been a psychiatric treatment for over 60 years, effective in reducing manic and depressive episodes. While beneficial for mood stabilization, some individuals experience side effects, with acne being a reported skin manifestation.
Lithium’s Effect on Sebaceous Glands
Lithium influences the skin’s sebaceous glands, which produce sebum, the skin’s natural oil. The medication can disrupt normal sebum production, potentially leading to an increase in oil that can clog pores. This disruption in sebum regulation contributes to an environment conducive to acne development.
Lithium may also alter the metabolism of vitamin A, a compound important for healthy skin cell turnover. This alteration can affect keratinocytes, the primary cells in the outer layer of the skin. Lithium’s influence on these cells may lead to hyperkeratinization (abnormal skin cell shedding), which can further contribute to the blockage of hair follicles and pores.
Lithium’s Role in Skin Inflammation
Lithium can also trigger or worsen inflammatory pathways within the skin. It is known to increase the production of inflammatory chemicals called cytokines, signaling molecules in the immune response. This increased cytokine activity can lead to redness, swelling, and the formation of inflammatory acne lesions.
The medication may also influence the activity of neutrophils, a type of white blood cell involved in fighting infection and inflammation. Some theories suggest that lithium can cause neutrophils to migrate from the bloodstream to the skin, where their increased presence can contribute to inflammation and the appearance of pimples. Lithium’s impact on these immune cells and inflammatory mediators can contribute to acne.
Characteristics and Management of Lithium-Induced Acne
Lithium-induced acne often manifests as persistent monomorphic papules or pustules, which are small, red bumps or pus-filled lesions. These breakouts typically appear on the limbs and trunk more frequently than on the face, though facial involvement can occur. Unlike typical adolescent acne, lithium-induced acne may not present with classic whiteheads or blackheads.
The onset of acneiform eruptions usually occurs within the first six months of starting lithium therapy, with some individuals experiencing symptoms within weeks. The severity of the acne can vary among individuals and does not always correlate with lithium blood levels. Lithium-induced acne can sometimes be resistant to conventional acne treatments.
If you are experiencing lithium-induced acne, communicate with your healthcare provider before making any changes to your medication. They may consider adjusting the lithium dosage or exploring other management strategies. General skincare principles, such as using gentle cleansers that contain salicylic acid, can be helpful. Opting for non-comedogenic beauty products, which are formulated not to clog pores, and choosing sunscreens with physical barriers like titanium dioxide or zinc oxide, may also support skin health.