Mood Stabilizers Vary in Skin Side Effects, but Severe Events Are Rare

Mood-stabilizing medications vary in their dermatologic side effects, but severe dermatologic adverse events are rare, a meta-analysis in the Journal of Psychiatric Research has found. 

Why It's Clinically Relevant

Dermatologic side effects—even if not severe—can be distressing to patients and lower their self-esteem and desire for social interactions. Knowing the likelihood of these side effects among different mood stabilizers can inform clinical decision making.

How It Worked

Researchers at the Mayo Clinic and colleagues analyzed data from 50 studies published from 1970 onward that investigated dermatologic adverse events associated with four mood stabilizers in adults and children diagnosed with bipolar disorder: lithium, lamotrigine, valproate, and carbamazepine.

By the Numbers

The most common dermatologic adverse event was rash, reported in 9.2% of patients who took lamotrigine, 6% who took carbamazepine, 2.9% who took valproate, and 1.3% who took lithium.

Other key findings:

• 4.2% of people taking lithium reported acneiform eruptions
• 1.9% of people taking lithium and 4.6% of those taking valproate reported hair loss.
• Just 0.04% of people taking lamotrigine reported severe skin reactions such as Stevens-Johnson syndrome or toxic epidermal necrolysis; severe reactions were not consistently reported for other medications.

 Treatment discontinuation because of dermatologic events was rare: less than 1% for lithium, valproate, and carbamazepine, and 2.6% for lamotrigine.

The researchers noted that while 28% of the studies were deemed to have a high risk of bias, a sensitivity analysis that excluded these studies produced largely consistent results. 

The Other Side

The pooled data reflects an average across a broad population of children and adults. Individual variables such as sex, age, and other medications being taken will influence the risk and severity of side effects.

Further, many of the included studies used patient self-report or assessments from non-dermatologists to identify adverse events, which may result in underreporting or misclassification of skin reactions.

What’s Next

“This review highlights the critical need for close monitoring during the initial treatment phase, as the risk of severe reactions is highest early on,” the researchers wrote. “Future studies should focus on identifying factors associated with these outcomes and exploring their potential impact on quality of life and treatment participation, and potential management strategies.”

Related Info:

Psychiatric News Special Report: “Psychodermatology: Bridging Dermatology and Psychiatry”

(Image: Getty Images/iStock/monstArrr_)