Psychotropic Medications and Dermatological Side Effects: An In-Depth Review
Abstract
:1. Introduction
1.1. Background
1.2. Pathogenesis: Mechanism and Risk Factors
1.3. Clinical Picture
2. Methodology
3. Morphology and Diagnosis
3.1. Morphology and Basics of Skin Lesions
3.2. Diagnosis
4. Cutaneous Adverse Drug Reactions
5. Management of ACDRs
6. Multidisciplinary Approach
6.1. Collaboration across Specialties
6.2. Integral Role of Nursing
6.3. Pharmacovigilance
7. Conclusions
Author Contributions
Funding
Conflicts of Interest
Abbreviations
ACDRs | Adverse cutaneous drug reactions |
ADRs | Adverse reactions |
AGEP | Acute generalized exanthematous pustulosis |
CBZ | Carbamazepine |
DRESS | Drug reactions with eosinophilia and systemic symptoms |
HLA | Human Leukocyte Antigen |
IV | Intravenous |
SJS | Stevens–Johnson syndrome |
SSRIs | Selective serotonin reuptake inhibitors |
TEN | Toxic epidermal necrolysis |
IgE | Immunoglobulin E |
AED | Antiepileptic drugs |
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Sex | Female |
---|---|
Ethnicity Thai | HLA-B 1502, 1518, 1521 |
Indian | HLA-B 1502, 1508 |
European | HLA-A 3101 |
Japanese | HLA-B 1518, HLA-B 3101 |
Han Chinese | HLA-B 1502 |
Type of drug used | AEDs, SSRIs |
Other factors | Polypharmacy |
Substance abuse |
Psychotropic Drug Class | Drug Type | Incidence of ACDRs [10] | Common Dermatological Manifestations |
---|---|---|---|
Antidepressants | SSRIs | 0.051% | Generalized skin rash, urticaria, rarely photosensitivity |
TCAs | 0.073% | Dry skin, sweating changes, rash, pruritus | |
Atypical antidepressants | Varies | Mild allergic skin reactions, photosensitivity, rare angioedema | |
Antipsychotics | Atypical antipsychotics | >1% | Drug-induced rash, photosensitivity, pruritus, dermatitis |
Typical antipsychotics | 0.1–1% | Mild allergic reactions, skin dryness, pigmentation changes | |
Anxiolytics | Benzodiazepines | 0.5–4% | Skin rash, pruritus, rare severe reactions like Stevens–Johnson syndrome |
Buspirone | - | Mild skin rashes, urticaria | |
Mood Stabilizers | Lithium | 0.01% | Acneiform eruptions, psoriasis exacerbation, pruritus, rare toxic epidermal necrolysis |
Anticonvulsant mood stabilizers | 0.23 | Skin rash, hypersensitivity reactions, alopecia | |
Stimulants | ADHD medications | Relatively rare, during treatment | Skin rash, pruritus, isolated cases of urticaria |
Drug Reactions | Characteristics | Differential Diagnosis | Remarks |
---|---|---|---|
Pruritis | - | - | Most common adverse event and is usually secondary |
Urticaria | Lesions with pale centres and red borders with migratory pattern | Immune-mediated and complement-mediated | Acute reaction and is associated with angioedema |
Exanthematous rashes | Macular and maculopapular painful lesions | Measles, scarlet fever, rubella, Duke’s disease, erythema infectiosum, erythema subitum | Seen within the first two weeks, may points towards a more serious effect |
Fixed drug eruptions | Oedematous lesions round to oval seen in skin and mucous membrane | May occur with analgesics and antibiotics | Acute onset, unknown aetiology |
Photosensitivity | Exaggerated sunburn of fixed eruptions following sun exposure | May occur with furosemide, thiazide, and nalidixic acid | Sunscreens and lotions might be effective |
Pigmentation | Commonly seen in skin, retina, and cornea | - | Associated with long-term use |
Alopecia | Reversible hair loss | May occur due to hormones, contraceptive pills, timolol, antimalarials, and antibiotics | Acute to subacute in onset |
Drug Reactions | Characteristics | Remarks |
---|---|---|
Erythema multiforme | Target lesions which vary in shape seen in extremities | May lead to more severe events, acute onset |
Steven–Johnsons syndrome (SJS) | Mucocutaneous lesions, most commonly bullous | Mortality due to sepsis |
Toxic epidermal necrolysis (TEN) | Bullous lesions on erythematous base involving more than a quarter of the body | Higher mortality rate |
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome | Drug eruption, eosinophilia, lymphadenopathy, multiple organ involvement | Lower mortality as compared to TEN |
Exfoliative dermatitis | Generalized exfoliation with pruritis | Good prognosis associated with withdrawal of the agent |
Drug hypersensitivity vasculitis | Inflammation of blood vessels with purpura | Immune-complex-mediated (type III) hypersensitivity reactions |
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Deb, N.; Dey, D.; Roy, P. Psychotropic Medications and Dermatological Side Effects: An In-Depth Review. Psychoactives 2024, 3, 22-34. https://doi.org/10.3390/psychoactives3010002
Deb N, Dey D, Roy P. Psychotropic Medications and Dermatological Side Effects: An In-Depth Review. Psychoactives. 2024; 3(1):22-34. https://doi.org/10.3390/psychoactives3010002
Chicago/Turabian StyleDeb, Novonil, Debankur Dey, and Poulami Roy. 2024. "Psychotropic Medications and Dermatological Side Effects: An In-Depth Review" Psychoactives 3, no. 1: 22-34. https://doi.org/10.3390/psychoactives3010002
APA StyleDeb, N., Dey, D., & Roy, P. (2024). Psychotropic Medications and Dermatological Side Effects: An In-Depth Review. Psychoactives, 3(1), 22-34. https://doi.org/10.3390/psychoactives3010002