Lamotrigine Subacute Cutaneous Lupus Erythematous

Objective: Lamotrigine is a new generation anticonvulsant, also used in bipolar type 1 disorders to prevent occurrence of mood episodes not responding to traditional antidepressant, which is an increasing indication worldwide. Skin adverse events occur in 5-10% of patients, but are usually mild and self-limiting. The occurrence of drug-induced lupus erythematosus is an uncommon, but severe condition, usually requiring discontinuation of the drug. Methods: A spontaneous pharmacovigilance case reporting is presented, following the causality assessment criteria, including temporal association with drug exposure, exclusion of other etiologies, dechallenge and rechallenge. Skin biopsy for normal histopathology and direct immunofluorescence was performed to assess the diagnosis of lupus erythematosus. Results: A 77 years old woman was hospitalized in the Dermatology Clinic of Cagliari University for a lamotrigine Induced Subacute Cutaneous Lupus Erythematosus, confirmed by improvement after drug dismission, and immediate recurrence at re-exposure. The last measure was performed on request of the neurologist with the consent of the patient, because of a high suicidal risk, not responding to traditional antidepressants, and well controlled by lamotrigine. Another peculiarity of our observation is a potential dose-related effects, as the patients was assuming lamotrigine from 2 years, and skin manifestations actually began 3 weeks after the dosage was doubled to 100 mg daily. Conclusion: If confirmed by other observation, drug-induced subacute cutaneous lupus erythematosus might be dose-dependent, and careful clinician’s dosage monitoring might prevent occurrence, preserving the lamotrigine use for the many patients who need it. Dermatologist referral is warrant in front of any suspect cutaneous adverse reaction due to psychotropic medications, to provide prompt recognition, adequate assessment and supportive management of such difficult and delicate patients.