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Lithium and Psoriasis — SCE Dermatology MCQ

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ModerateDrug ReactionsLithium and PsoriasisSCE Dermatology

A 55-year-old man with psoriasis has co-existing depression treated with Lithium. His psoriasis has worsened since starting Lithium. Is there an association?

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Correct answer: CYes — Lithium is a well-known trigger/exacerbator of psoriasis; it can induce new psoriasis or worsen existing disease, often treatment-resistant

Lithium is a well-established psoriasis trigger/exacerbator. It worsens existing psoriasis in approximately 40-45% of patients and can induce new-onset psoriasis. The mechanism involves Lithium inhibiting inositol monophosphatase and glycogen synthase kinase-3 (GSK-3), leading to increased keratinocyte proliferation and neutrophil chemotaxis. Lithium-exacerbated psoriasis is often treatment-resistant. Management options: discussion with psychiatry about alternative mood stabilisers (Valproate, Lamotrigine), optimisation of psoriasis treatment (may require biologic escalation), and careful monitoring. Stopping Lithium should only be considered in discussion with the prescribing psychiatrist — abrupt Lithium cessation risks psychiatric relapse and should never be done without specialist input.

Reference: BAD 2020 Psoriasis; Drug-Induced Psoriasis Review