Lithium’s Ugly Side Effect: Acne

Occasionally I bring up the topic of medication side effects, and this is one that affects my daily life. I’m referring to acne as an irritating side effect of Lithium. Screen shot 2014-02-03 at 5.38.09 PMLithium is the most widely used and studied medication for treating bipolar disorder. Lithium helps reduce the severity and frequency of mania and helps stabilize moods. It has a list of common side effects, including hand tremors, increased thirst, weight gain, drowsiness, muscle weakness, hair loss, decreased thyroid function, and acne.  While the side effects are not always easy to live with, Lithium can be a life-saving medication for so many people. The side effect I want to focus on is one that is often overlooked because it is not always considered medically troublesome. This side effect is acne.

I have been taking Lithium for almost a year and a half now and my skin hates me for it! Prior to taking this medication, I would have an occasional breakout, but nothing like I do now. At the time of being prescribed the Lithium, my psychiatrist didn’t really explain any side effects. I think this is due to the fact I was in crisis mode, suffering a severe mixed episode. He also prescribed two other medications to take with the Lithium, while discontinuing the meds I was already on. There was a lot of change going on and I probably wouldn’t have been able to fully comprehend anything too detailed anyway.

When I first started noticing my skin breaking out, I didn’t connect it to my medication. I used several different drugstore brand cleansers and ointments. I make sure to drink plenty of water and eat healthy. I wash twice a day and remove all makeup at night. I learned how to use concealer and other makeup tricks. I cried on occasion and I sometimes avoided going out with friends. My biggest problem wasn’t necessarily that I had the acne, but I really wanted to know why I had it. Then I started thinking that maybe things I put on my face aren’t working because it has to do with what I put in my body. The chemicals I put in my body. Since I don’t smoke or drink or anything like that, the only chemicals I’m really ingesting are my medications. After doing some research, I found that acne, sometimes chronic, is definitely a side effect of Lithium.

Not everyone who takes lithium develops acne, but many do. The reason lithium triggers acne is counterintuitive. It increases the activity of the immune system which in turn increases skin inflammation.

Lithium causes a condition called leukocytosis. The technical definition of leukocytosis is an increase in white blood cell (WBC) count due to any cause. When people who have bipolar affective disorder take lithium, the drug causes them to produce more stress hormones (which is actually a good thing) when they are depressed. These stress hormones make it easier to find the energy to function day by day.

Stress hormones in the skin, however, increase inflammation. They trigger the release of histamine from storage packets in the skin. Histamine is the same chemical that causes allergies. It breaks down skin cells or cells in the membranes lining the nose and throat to remove foreign bodies and germs. When the release of histamine is induced by stress, however, histamine destroys healthy tissue that has not been penetrated by foreign bodies or infected by germs. The result is redness, itching, and even pain in the skin that is worse in pores that are affected by acne.

Okay so now we have a cause for the ugly blemishes, but how do you get a handle on the situation?

If your acne is bothersome, decreasing your lithium dosage with your doctor’s consent can often help your skin improve. If that’s not possible, it’s best to consult a dermatologist about acne treatments, since lithium-induced pimples are generally harder to get rid of than other types of blemishes.

One possible treatment for this type of acne is tretinoin (Retin-A, Renova, Atralin), a topical drug that works by unclogging pores and promoting peeling of the affected skin. However, it is important to talk to your doctor about possible side effects before using this medication.

The drug isotretinoin (previously marketed as Accutane, but now available only as a generic) should be considered only if absolutely necessary, since its reported side effects include birth defects, depression, and psychosis (feelings of delusion and hallucination). This can be especially dangerous for someone with bipolar disorder. “You should proceed with caution so you don’t have some sort of manic or depressive episode,” says Amy Derick, MD, a dermatologist in Barrington, Ill.

Having a good anti-acne skin care routine can also be helpful in fighting breakouts while you are taking lithium. An over-the-counter cleansing product that contains salicylic acid, which reduces swelling and unclogs pores, should be used twice a day for optimum results.

When buying beauty products, such as moisturizer or foundation, be sure that the label says that the formula is “non-comedogenic,” meaning it has been formulated to not clog pores, which can lead to breakouts. Also, choose a sunscreen that uses titanium dioxide or zinc oxide as a physical barrier against the sun, rather than chemicals that absorb UV rays. “Those types of sunscreens are usually better for people who have acne problems,” Derick says.

Finally, try not to get too down about your acne. Some patients on lithium have found that their skin problems decrease after about six months of treatment, as their bodies adjust to the new medicine. “It can get better,” Derick says.

So what am I going to do? While I would like to be able to decrease my Lithium, it simply isn’t an option. I will continue to practice healthy habits like washing twice a day, using clean towels and pillow cases, and eating healthy. I also ordered an acne cleansing system, Proactive Plus. (I do not endorse any products.) This product has gotten good reviews, so I figured it can’t hurt to give it a try. I don’t expect to get rid of the acne completely. I just want to feel attractive again. I hate being self conscious over my skin. I feel a little less stressed about my complexion since knowing the assumed cause of the issue. Hopefully this information helps out any of you with similar side effects.

10 thoughts on “Lithium’s Ugly Side Effect: Acne

  1. Hi there
    I came across this blog when doing a Google search for Lithium and acne. I’ve been on Lithium fur 18 years, I’m 41 now and considering starting Roaccutane as I have never been able to get a handle on my lithium induced acne. I’m interested to know if you have been successful in treating your acne and if so, what works best for you. Thanks in advance.

    • Hi Inga. Glad you found this article. The side effects of Lithium & many other of the strong meds are extremely frustrating. I cried over my acne. I felt gross & didn’t want to show my face.

      I have been using the ProActive + for about 3 years now. It has helped manage my acne. I still get isolated breakouts, but nothing like I was experiencing. I’d estimate that the breakouts overall have been reduced by about 65-70%. The ProActive doesn’t cure it or zap it at the root cause, but for me it has controlled what is present and then helps prevent new blemishes. (I have no affiliation with Rodan Fields/ProActive, I’m just a customer.) Also know when I first began using it, it dried out my face something awful & I was afraid to continue. I’m glad I did because that subsided & my skin evened out.

      I also drink tons of water. I mean tons. You will never see me without a glass or bottle of water. If I order a tea at a restaurant, I also order a water- and drink the whole thing. On a good day, I consume about a gallon of water. The key is to just consistently have it on you. Hydration helps big time with skin. To break up monotony, I put lemons in my water.

      I spend more time in steam & keep my hair clean, free of products, especially when going to bed. I change my pillowcase at least 3 times per week. Another tip I read somewhere that I like is when you wash your face, wash it twice. The first lather & rinse removes makeup & environmental toxins, while doing it a 2nd time deep cleans your face.

      I hope this was helpful. You could even ask your doctor what he/she might recommend. You could try biotin supplements. Personally, they didn’t make a difference, but I don’t want to discourage anything potentially helpful.

      Please check back & let me know your progress on the situation. I wish you best!

  2. This is really helpful with lots of interesting facts, but also depressing! I used to get about 1 spot a month maybe two, now I have a full set around my mouth and chin, it’s horrible. Made even worse by the fact I just had a brace fitted that makes me super self concious already! The bit that made me nearly cry was going out in a lovely new halter neck dress and finding my shoulders were also really spotty just as the sun comes out. Gutted. Am wondering if a diff med might work for me ..

    • I’m sorry you’re dealing with this. I will say after about a year & a 1/2, & using the proactive + solution, my face has cleared up considerably. I’m thinking my system finally got used to it..? Plus I’m on other medications that I think my body is now accustomed to. If it’s really bothersome, & trust me I know how bad it can feel, then explore your options. Lamictal is a comparable mood stabilizer to lithium. My doctor just added that to help with my lithium in balancing moods. I wish you the best & hope you find relief!

  3. I have had severe acne episode a couple of months ago, but this is mainly due to poor lifestyle (lack of sleep, less water and smoking). I cut back on smoking, slept well and more, avoided oily foods/ate healthier) and my skin behaved well. I hope you find the best skin care that will work out well for you. Thanks for sharing your story. Cheers! – Lorie Holland

  4. I am currently dealing with this exact problem, which is how I found your blog. I have been on Lithium for 6 weeks now and have broken out in places I have NEVER broken out before. I already use proactive, so that’s not going to help. Guess its off to the derm. Hate to see others have to suffer too, but it does make me feel better that I’m not alone.

    • I’m sorry to see that you are going through this too. I feel like Lithium is blessing with a lot of little curses in tow. I have continued the Proactive system, along with using a Neutrogena face bar. I don’t know if it’s the combination of the two, or sleeping with a fan on (to avoid any sweating at night), drinking a TON of water, giving up sugar & fried foods, and taking vitamins- but after a year & a half, my face seems to be behaving for the most part. (Knock on wood!) Maybe it took that long for my body to get used to it. I’m not sure. I wish you so much luck with this. It can be really discouraging after awhile. If you do see a derm, I hope it works out for you. Thanks for stopping by my blog. Please feel free to share updates 🙂

  5. I’m starting lithium this week so i can’t comment on it causing acne for me. But I am and have been on other meds that caused acne. I went and got retinol cream from the derm, at first acne got way worse and then better. She said I could add in a benzoyl face cleaner, like proactive. I had some but it wasn’t helping much. I guess the % of benzoyl is not very high in proactive. I found the clean and clear face wash which has 10% i think and is way cheaper 🙂 That does the job combined with the retinol. I still get the monthly breakout or cystic acne. The only thing is the clean and clear wash makes the skin around my eyes red and itchy so i have to try really hard not to get any around my eyes!! Good luck I hope you find a combo that helps with your acne!

  6. When I was dealing with bad acne the thing that really helped me was Burt’s bees facial cleanser and scrub. I would use the cleanser daily and the scrub once a week. I also really liked the origins charcoal mask.

    I hope you find some relief 🙂

Tell us your thoughts.

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s