Letter to Editor
BibTex RIS Cite

Successful management of lamotrigine-associated skin rashes in an adolescent girl with autism and bipolar disorder

Year 2024, Volume: 49 Issue: 4, 1104 - 1106, 30.12.2024
https://doi.org/10.17826/cumj.1396271

Abstract

Lamotrigine, an antiepileptic class drug, is an agent that can be used as a mood stabilizer in children and adolescents and skin rashes as a side effect are seen. Rarely, Stevens Johnson Syndrome may develop with skin rashes that may be mortal accompanied by systemic symptoms. In this paper, lamotrigine was started as a mood stabilizer in addition to the current olanzapine treatment in an 18 years old adolescent girl with autism spectrum disorderand bipolar disorder type 2. After the dose was increased, erythematous acneiform rash developed on the 10th day. Then, lamotrigine was discontinued and skin rashes regressed. Slowly titrating lamotrigine dose, noticing skin rashes on treatment and be able to distunguish bening and malign rash are so helpful for clinicians. An 18 years old adolescent girl who was followed up with the diagnosis of autism spectrum disorder and bipolar disorder was started on lamotrigine as a mood stabilizer in addition to the current olanzapine treatment. On the 10th day of treatment, erythematous acneiform skin rashes appeared on the face. After the dermatology consultation response, the drug was discontinued and the skin rashes regressed within 1 week.
The fact that the skin rashes appeared in the head-neck region, were mildly painful, tended to coalesce, and resolved when the drug was discontinued, suggested that might be malign rash. The absence of systemic symptoms, intact blood values and no additional treatment is required, suggested that might be benign rash. Further studies are needed on the use of lamotrigine in children and adolescents with autism spectrum disorder.

Project Number

1

References

  • Matsuo F, Bergen D, Faught E, Messenheimer JA, Dren AT, Rudd GD et al. Placebo-controlled study of the efficacy and safety of lamotrigine in patients with partial seizures. U.S. Lamotrigine Protocol 0.5 Clinical Trial Group. Neurology. 1993;43:2284-91.
  • Reid JG, Gitlin MJ, Altshuler LL. Lamotrigine in psychiatric disorders. J Clin Psychiatry. 2013;74:675-84.
  • Guldiken G, Karayagmurlu A, Kucukgergin C, Coskun M. VEGF, IGF-1 and FGF-2 serum levels in children and adolescents with autism spectrum disorder with and without bipolar disorder. J Autism Dev Disord. 2024;54:3854-62.
  • Uludag Gedik C, Karayagmurlu A, Kucukgergin C, Bingul I, Coskun M. Peripheral markers of nitrosative stress in children with autism spectrum disorder and bipolar disorder comorbidity during euthymic phase. Res Autism Spectr Disord. 2023;109:102259.
  • Pavuluri MN, Henry DB, Moss M, Mohammed T, Carbray JA, Sweeney JA. Effectiveness of lamotrigine in maintaining symptom control in pediatric bipolar disorder. J Child Adolesc Psychopharmacol. 2009;19:75-82.
  • Nielsen JN, Licht RW, Fogh K. Two cases of acneiform eruption associated with lamotrigine. J Clin Psychiatry. 2004;65:1720-2.
  • Besag FM, Ng GY, Pool F. Successful re-introduction of lamotrigine after initial rash. Seizure. 2000;9:282-6.
  • Sassolas B, Haddad C, Dunant A, Allanore LV, Roujeau JC. Evolution in europe of the causes of SJS/NET linked to high risk medicines. Analysis over 10 years.Ann Dermatol Venereol. 2011;138:89-92.
  • Lorberg B, Youssef NA, Bhagwagar Z. Lamotrigine-associated rash: to rechallenge or not to rechallenge?. Int J Neuropsychopharmacol. 2009;12:257-65.

Otizm ve bipolar bozukluğu olan bir ergen kızda lamotrijin ilişkili deri döküntülerinin başarılı yönetimi

Year 2024, Volume: 49 Issue: 4, 1104 - 1106, 30.12.2024
https://doi.org/10.17826/cumj.1396271

Abstract

Antiepileptik sınıfı bir ilaç olan Lamotrijin, çocuk ve ergenlerde duygu durum dengeleyici olarak kullanılabilen ve yan etki olarak deri döküntüleri görülen bir ajandır. Nadiren sistemik semptomların eşlik ettiği ölümcül olabilen deri döküntüleri ile Stevens Johnson Sendromu gelişebilmektedir. Bu yazıda, otizm spektrum bozukluğu ve bipolar bozukluk tip 2 tanılı 18 yaşında bir ergen kız hastaya mevcut olanzapin tedavisine ek olarak duygudurum dengeleyici olarak lamotrijin başlanmıştır. Doz artırıldıktan sonra 10. günde eritematöz akneiform döküntü gelişti. Daha sonra lamotrijin kesildi ve deri döküntüleri geriledi. Lamotrijin dozunu yavaşça titre etmek, tedavi sırasında deri döküntülerini fark etmek ve bening ve malign döküntüyü ayırt edebilmek klinisyenler için çok yararlıdır. Otizm spektrum bozukluğu ve bipolar bozukluk tanılarıyla takip edilen 18 yaşındaki ergen kız hastaya mevcut olanzapin tedavisine ek olarak duygudurum dengeleyici olarak lamotrijin başlandı. Tedavinin 10. gününde yüzünde eritematöz akneiform deri döküntüleri ortaya çıktı. Dermatoloji konsültasyonunun yanıtının ardından ilaç kesildi ve deri döküntüleri 1 hafta içinde geriledi. Deri döküntülerinin baş-boyun bölgesinde ortaya çıkması, hafif ağrılı olması, birleşme eğiliminde olması ve ilaç kesildiğinde düzelmesi malign döküntü olabileceğini düşündürmüştür. Sistemik semptomların olmaması, kan değerlerinin bozulmamış olması ve ek tedaviye gerek duyulmaması iyi huylu bir döküntü olabileceğini düşündürmüştür.

Project Number

1

References

  • Matsuo F, Bergen D, Faught E, Messenheimer JA, Dren AT, Rudd GD et al. Placebo-controlled study of the efficacy and safety of lamotrigine in patients with partial seizures. U.S. Lamotrigine Protocol 0.5 Clinical Trial Group. Neurology. 1993;43:2284-91.
  • Reid JG, Gitlin MJ, Altshuler LL. Lamotrigine in psychiatric disorders. J Clin Psychiatry. 2013;74:675-84.
  • Guldiken G, Karayagmurlu A, Kucukgergin C, Coskun M. VEGF, IGF-1 and FGF-2 serum levels in children and adolescents with autism spectrum disorder with and without bipolar disorder. J Autism Dev Disord. 2024;54:3854-62.
  • Uludag Gedik C, Karayagmurlu A, Kucukgergin C, Bingul I, Coskun M. Peripheral markers of nitrosative stress in children with autism spectrum disorder and bipolar disorder comorbidity during euthymic phase. Res Autism Spectr Disord. 2023;109:102259.
  • Pavuluri MN, Henry DB, Moss M, Mohammed T, Carbray JA, Sweeney JA. Effectiveness of lamotrigine in maintaining symptom control in pediatric bipolar disorder. J Child Adolesc Psychopharmacol. 2009;19:75-82.
  • Nielsen JN, Licht RW, Fogh K. Two cases of acneiform eruption associated with lamotrigine. J Clin Psychiatry. 2004;65:1720-2.
  • Besag FM, Ng GY, Pool F. Successful re-introduction of lamotrigine after initial rash. Seizure. 2000;9:282-6.
  • Sassolas B, Haddad C, Dunant A, Allanore LV, Roujeau JC. Evolution in europe of the causes of SJS/NET linked to high risk medicines. Analysis over 10 years.Ann Dermatol Venereol. 2011;138:89-92.
  • Lorberg B, Youssef NA, Bhagwagar Z. Lamotrigine-associated rash: to rechallenge or not to rechallenge?. Int J Neuropsychopharmacol. 2009;12:257-65.
There are 9 citations in total.

Details

Primary Language English
Subjects Child and Adolescent Psychiatry
Journal Section Letter to the Editor
Authors

Zeynep Kübra Göksu 0000-0003-4316-5043

Ali Karayağmurlu 0000-0001-5464-2891

Project Number 1
Publication Date December 30, 2024
Submission Date November 26, 2023
Acceptance Date May 9, 2024
Published in Issue Year 2024 Volume: 49 Issue: 4

Cite

MLA Göksu, Zeynep Kübra and Ali Karayağmurlu. “Successful Management of Lamotrigine-Associated Skin Rashes in an Adolescent Girl With Autism and Bipolar Disorder”. Cukurova Medical Journal, vol. 49, no. 4, 2024, pp. 1104-6, doi:10.17826/cumj.1396271.