Psoriasiform and acneiform lesions in a patient with bipolar disease

Clinical examination revealed well-defined erythematous scaly papules and plaques with white semiadherent scales with mild-to moderate induration over the scalp, chest, back and upper extremities (figures 1 and 2). [...]the incidence of psoriasis secondary to lithium treatment has been reported to be from 1.8% to 6%.1 The mechanism by which lithium induces psoriasis is not clearly understood, however lithium has a role in modulating adenyl cyclase and inositol monophosphatase-mediated pathways.2 The decrease in cyclic adenosine monophosphate and inositol as a result of lithium treatment causes low intracellular levels of calcium, leading to lack of differentiation and increased proliferation of keratinocytes, enhanced chemotaxis and phagocytic activity of polymorphonuclear leucocytes.3 Lithium is associated with a variety of cutaneous side effects including psoriasis. Dermatologists, psychiatrists and family physicians should be aware of this association. [...]early detection can help in avoiding further deterioration of symptoms of bipolar disease secondary to disfguring skin appearance.