Table 2.

Management Guidelines for Lithium-Induced Production or Exacerbation of Psoriasis

Detailed personal, social, and family history and history of psoriasis before considering lithium therapy

Psychodermatologic evaluations at frequent intervals during the treatment course to recognize psoriatic lesions and address potential issues with low self-esteem and treatment compliance

Mild to moderate disease: conventional treatment such as topical steroids, vitamin D analogues, retinoids, methotrexate, and PUVA (psoralen and ultraviolet A) therapy

Severe disease: discontinue lithium treatment and request dermatology/psychodermatology consult. Reduction of dose could be another option reasonable and worth trying in these cases

Consistent liaison among primary care physician, psychiatrist, and dermatologist regarding the management of psoriasis

Patient and family education regarding the association of lithium and psoriasis and provision of alternative medications