Abstract
Psychotropic medications can be associated with dermatologic side effects. The aim of this review is to explore the skin reactions of such psychotropic medications. In our method we conducted a PubMed literature search using the key words; psychotropics, antipsychotics, antidepressants, mood stabilizers, anticonvulsants, cutaneous reactions and skin reactions. The results of this review indicate that psychotropic medications can contribute to several adverse cutaneous manifestations with varied severity ranging from benign skin reactions to rare life-threatening ones such as toxic epidermal necrolysis and Stevens-Johnson syndrome. Psychotropic medications can also aggravate pre-existing skin conditions or trigger the manifestation of dormant one such as lithium-induced psoriasis. Cross sensitivity reactions may exist between medications of the same class or between the medications of different class. Careful history taking and continued monitoring and observation of psychotropic medications is important for recognition and early management of adverse cutaneous reactions particularly during the first 2 months of starting treatment.
Financial & competing interests disclosure
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
No writing assistance was utilized in the production of this manuscript.
Key issues
• Although not specific for psychotropic medications, adverse cutaneous reactions can be associated with all types of psychotropic medications.
• Adverse cutaneous reactions can be divided into: common, usually relatively benign, skin reactions and serious skin reactions. A third group of cutaneous reactions involve primary skin conditions precipitated or aggravated by medications.
• Hyperpigmentation occurs most often with low potency typical antipsychotic medications such as chlorpromazine.
• Drug-induced alopecia may occur rapidly or a few months after starting psychotropic medications and commonly occurs with lithium and valproic acid.
• Use of mood stabilizers, such as carbamazepine and valproate, can be significantly associated with severe reactions such as erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis. Drug reaction with eosinophilia and systemic symptoms syndrome can occur with using antiepileptic drugs; more commonly with aromatic drugs.
• Several cutaneous reactions have been reported in association with lithium such as psoriasis, acneiform eruptions, maculopapular eruptions and follicular eruptions. Pharmacokinetic interactions may occur between dermatologic and psychotherapeutic medications due to inhibition of CYP-mediated drug metabolism.
• Monitoring for possible adverse reactions during the first few months of starting medication is recommended for early management particularly when a life-threatening reaction is suspected.