EXACERBATION OF DARIERS-DISEASE WITH ORAL LITHIUM-CARBONATE THERAPY

Darier's disease is a rare, autosomal dominant disorder with well-reco gnised cutaneous manifestations. A high incidence of psychiatric distu rbance has become well-established in this disease although the reason s for this are still unclear. We report a case of a 46-year-old female patient with Darier's disease also suffering from manic depression, w hose rash flared dramatically soon after starting lithium carbonate th erapy, despite concurrent treatment with acitretin. We discuss other c utaneous disorders associated with lithium therapy and mechanisms for its effect in Darier's disease. It is possible that lithium inhibits e pidermal adenylate cyclase, leading to a reduction in intracellular cy clic AMP and a proliferation of epidermal cells, an effect previously found in vitro. Finally, we discuss the association of Darier's diseas e with other psychiatric disorders, and emphasize the potentially seri ous complications of lithium administration in such patients.