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Homicidal Ideation Secondary to Interferon

The Annals of Pharmacotherapy ■ 2001 July/August, Volume 35 www.theannals.com Discussion. Lithium remains a drug of choice for the treatment of bipolar disorder. Psoriasis, maculopapular eruptions, ulcers, keratosis pilaris–like folliculitis, exfoliative dermatitis, dermatitis herpetiformis– like eruption, and hair loss are all reported as cutaneous adverse effects of lithium therapy. However, the most common cutaneous adverse effect seems to be acne lesions.3 As far as we know, this is the first case to be published in which the drug-induced lesions continued to appear for such a long period of time after cessation of the causative agent. Kanzaki4 reported a woman taking lithium therapy who showed acneic changes that resolved three months after discontinuation of the drug. Gupta et al.5 reported a case of lithium-induced hidradenitis suppurativa that improved 24 weeks after the cessation of lithium therapy. Although, according to Gupta et al., comedones and cysts are typically not present, we examined giant open comedones and cystic lesions in our patient. These kinds of acneic lesions can also be seen in patients with no drug history. They may be secondary to sun exposure, cosmetics, and topical ointments used, or mechanical factors (i.e., tensions, frictions, pressures). However, we could not detect any cause of acne in our patient other than lithium intake. Hidradenitis suppurativa, dissecting cellulitis of the scalp, and acne conglobata are all known to be included in follicular occlusion triad. These lesions are usually resistant to therapy and spontaneous resolution cannot be expected. Once they occur, whether drug induced or not, aggressive therapies with surgical and systemic agents should be performed. Our patient’s case seems to be unusual, as the comedones and cysts that developed following lithium therapy continued for a long period of time and in a severe pattern after the drug was stopped.