From the Guidelines
Lithium medication can cause acne by affecting several skin-related processes in the body, including increasing the production of inflammatory chemicals, disrupting normal sebum production, altering vitamin A metabolism, and affecting hormone levels, particularly androgens. The exact mechanisms by which lithium leads to acne formation are complex and multifactorial. Lithium increases the production of inflammatory chemicals called cytokines, which trigger skin inflammation and acne formation 1. It also disrupts normal sebum (skin oil) production, leading to excess oil that can clog pores. Additionally, lithium alters the metabolism of vitamin A, which is essential for healthy skin cell turnover. The medication can also affect hormone levels, particularly androgens, which further stimulates oil production.
These acne breakouts typically appear on the face, chest, and back, and often develop within the first few months of starting lithium treatment. The severity of acne varies among patients and doesn't necessarily correlate with lithium blood levels. If you're experiencing lithium-induced acne, don't stop your medication, but consult your psychiatrist who may adjust your dosage or prescribe topical treatments like benzoyl peroxide or retinoids, as recommended by recent guidelines for the management of acne vulgaris 1. In some cases, oral antibiotics or dermatology referral might be necessary while maintaining your essential lithium therapy.
Some key points to consider in the management of acne, including lithium-induced acne, include:
- Using topical therapies combining multiple mechanisms of action
- Limiting systemic antibiotic use
- Combining systemic antibiotics with benzoyl peroxide and other topical therapies
- Adding intralesional corticosteroid injections for larger acne lesions as an adjuvant therapy, as recommended by good practice statements 1. It's essential to follow the most recent and highest quality guidelines for the management of acne vulgaris, such as those published in the Journal of the American Academy of Dermatology 1, to ensure the best possible outcomes in terms of morbidity, mortality, and quality of life.
From the FDA Drug Label
Dermatologic: Drying and thinning of hair, anesthesia of skin, chronic folliculitis, xerosis cutis, alopecia and exacerbation of psoriasis. The lithium medication can lead to acne formation through the development of chronic folliculitis, which is a type of skin inflammation that can cause acne-like symptoms.
- Key points:
- Dermatologic side effects of lithium include chronic folliculitis
- Chronic folliculitis can cause acne-like symptoms
- Lithium can also cause other skin-related side effects, such as drying and thinning of hair, and exacerbation of psoriasis 2
From the Research
Mechanism of Acne Formation
- Acne vulgaris is an inflammatory disease of the pilosebaceous unit of the skin, primarily involving the face and trunk, and affects approximately 9% of the population worldwide 3.
- The pathophysiology of acne vulgaris involves alterations in sebum production, inflammation, follicular hyperkeratinization, and Cutibacterium acnes (C. acnes) proliferation 4.
Role of Sebum in Acne Pathogenesis
- Sebum production is driven by androgens and plays a crucial role in the development of acne vulgaris 4.
- Changes in sebum secretion and composition are believed to be important factors in acne occurrence, with increased sebum secretion inducing acne and sebum component changes strongly related to acne occurrence 5.
Lithium Medication and Acne Formation
- There is no direct evidence in the provided studies to suggest that lithium medication leads to acne formation.
- However, it is known that certain medications, including those that affect hormone levels, can contribute to acne development 3.
- Further research is needed to determine the specific relationship between lithium medication and acne formation, as the current evidence does not provide a clear link between the two 3, 6, 7, 4, 5.