A Rare Phenomenon of Lithium-Associated Acne Inversa: A Case Series and Literature Review

Abstract

Lithium use has been associated with dermatological issues, including psoriasis, folliculitis, and acneiform outbreaks. The lithium dosage and the therapeutic range of serum lithium levels are closely correlated with the frequency of cutaneous adverse effects. Lithium-induced acne inversa is a less well-known adverse effect, causing significant morbidity. Acne inversa (hidradenitis suppurativa) is a chronic inflammatory illness of the skin seen in the folds of the skin and face and distinguished by the presence of painful nodules and fistulas, as well as a propensity for tissue fibrosis. We report two cases of bipolar affective disorder who received long-term lithium treatment and experienced acne inversa during treatment, which subsided once the lithium was withdrawn.

Keywords: acne inversa; bipolar affective disorder; hypoxia-induced factor-1; lithium; neutrophilia.

Figure 1. Multiple severe cystic eruptions, papules, nodules, and comedones with some sinus tracts and scarring.

Figure 2. Multiple bumps, including nodules and comedones with some sinus tracts and scarring.