Generalized pustular psoriasis precipitated by lithium carbonate

Area of Science:

• Dermatology
• Psychiatry

Background:

• Psoriasis vulgaris is a chronic inflammatory skin condition.
• Manic-depressive psychosis is a mood disorder.
• Lithium carbonate is a common treatment for bipolar disorder.

Observation:

• A patient with stable psoriasis vulgaris developed generalized pustular psoriasis after initiating lithium carbonate therapy.
• The patient experienced methotrexate toxicity during the acute phase of the pustular psoriasis.
• Photochemotherapy was administered and proved effective in managing the generalized pustular psoriasis.

Findings:

• Lithium carbonate therapy precipitated generalized pustular psoriasis in a patient with pre-existing psoriasis vulgaris.
• Methotrexate toxicity occurred during the acute illness phase.
• Photochemotherapy was an effective treatment modality.
• Pustulation recurred upon reintroduction of lithium carbonate therapy, indicating a direct link.

Implications:

• Lithium carbonate should be used with caution in patients with psoriasis vulgaris.
• Close monitoring for dermatological side effects is crucial during lithium therapy.
• Alternative mood stabilizers may be considered for patients with psoriasis.
• Understanding drug-induced psoriasis exacerbations is vital for patient management.