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. http://www.facingacne.com/lithium-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. http://www.everydayhealth.com/bipolar-disorder/when-lithium-causes-acne.aspx

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.

When Obstacles Mock Your Progress

Responsibilities can be a pain. Especially those that directly pertain to treating my bipolar disorder. When I actually do focus and commit to handling something of importance, I feel like I’m on top of things for once. Then on occasion, just when you think the stars are aligned, and you’re coming out ahead, stupid annoyances create stubborn roadblocks to your personal victory. Where am I going with this? Okay, it started yesterday when I attempted to connect with Quest Diagnostics, a medical testing lab, to inquire about Lithium level testing (I usually go to my doctor’s office, but that is no longer feasible). I wanted a price in case my crappy insurance didn’t cover it. Alright, easy enough. I had already put off testing for a week too long and it is getting close to my next appointment, so I took the initiative (meaning- my wife didn’t have to get on my ass), and I called first thing in the morning. Line was busy. No problem, I’ll call back in a bit. Line still busy. Damn, maybe there is something wrong with their phone. I waited an hour and a half, then called again. Ring ring ring- answering machine. Really? Waited another half hour and called back. This time a woman answered. I explained what I needed. She literally told me that she was busy with a patient and that I needed to call back in 10-15 minutes. Now, having worked customer service for several years, I know professional etiquette would have been to take my info and call me back. But whatever. I was in control of this. At this point, I had been at work, in my office, alone. I knew my boss would be here shortly and since I am not out with my bipolar at work, I was really hoping to resolve this without providing him any of my personal business. For safe measure, I gave the woman 20 minutes before I dialed again. Ring ring ring- line busy. Fucking really? Needless to say, I never connected with the lab. And it made me a little anxious because I tend to put off important phone calls, appointment scheduling, and paperwork deadlines. I was nervous that if I didn’t do it yesterday, I wouldn’t do it at all. Damn roadblocks.

Okay, with a fresh mindset, I came to work this morning, and since I was alone, it was safe to call Quest and take care of business already. Ring ring ring- BUSY! I couldn’t believe it. Again I waited about 20 minutes, and yep- still busy. I was now getting angry, but talked myself into taking the proactive route. I Googled other Quest locations, in the hopes that maybe I was just lucky enough to get the incompetent lab office, and even though it was the most convenient location for me, perhaps someone else be of assistance. I called another office and wouldn’t you believe I let that phone ring until the office answering machine picked up. Unbelievable. At this point I gave up. It takes a great deal of effort for me to remember to stay on top of these things, and when the other party can’t get their own situation figured out, it creates problems for me. The bigger problem is that I’ve been trying to connect with them for two days, and I still need to have my blood work done. In a way, my health is being compromised because a company cannot do their job. The only option that could get me anywhere is if I just go down to the lab tomorrow, in person. I hope I don’t need an appointment, because if I do, I have a feeling I may show them how quickly my moods really can swing!

Hair Loss Is Just Another Side Effect

Let’s talk side effects for a minute. Common ones are dry mouth, tremors, sleepiness, upset stomach, and weight gain. What about hair loss? I’m talking constant loose strands, hair falling to the floor every time I touch my head, handfuls when I shampoo. I keep a Swiffer vac by my side whenever I blow dry and straighten my hair because otherwise the bathroom is decorated with what has released from my scalp. For months now I have been attributing this to everything from what I was eating, to needing a haircut, using the wrong shampoo, not washing it enough, washing it too much, not brushing it enough, brushing it too much- you catch my drift.

Then it dawned on me that this began around the time my medication was switched and I started on Lithium. After doing a little research, I have now learned that I’m not alone in this situation. According to bipolar.about.com, Lithium and Depakote are common culprits in the hair loss manifesto.

Lithium can cause thyroid problems which are associated with losing hair. Other than that, it isn’t specifically known why certain drugs cause thinning hair, but what happens is a process called telogen effluvium. Normally, most hair is in the active growing phase, while a much smaller proportion is in the resting, or telogen, phase. Growing hair pushes the resting hair out. When a medication causes many more hair follicles to enter the resting stage than is usual, there is less hair growing and more to be pushed out — or pulled out, whether by shampooing, brushing and combing, or just running your hands through your hair.

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At this point, I am really getting tired of dealing with this. I also find it interesting that it is a side effect you don’t hear about very much. I have been on several different cocktails and have experienced a rainbow of side effects, but this is new for me. I just had an appointment with my psychiatrist and I didn’t think to mention it, but at my next appointment I definitely will see what he says. As for everything I’ve read on how to remedy this situation, decreasing or discontinuing the medication is the most effective solution. Unfortunately, this will not be an option for me right now. I feel better than I did 6 months ago, and I know the meds play a huge role in that. Now I’m just curious if anyone here else has experienced this and how you’ve handled it.