Lithium And Acne: What’s the Connection?

By Dr. Jaggi Rao, MD, FRCPC, Double board-certified dermatologist

Lithium has been a mainstay of treating bipolar disorder for many years. Although other medications are also often used to treat this commonly diagnosed psychiatric condition, when the cost of medication is a major concern, lithium is almost always the medication of choice. One of the serious potential side effects of lithium treatment, however, is acne. And it’s not just lithium as a medication, but also lithium in food and drinking water, than can be a concern.

Acne can be a common side effect of products containing Lithium.

What Is Lithium?

Lithium is the lightest of all the metal elements. It is used to make ceramics and glass, in lubricants, and in the manufacture of batteries. All living creatures contain small amounts of lithium, especially plants and animals that live in the sea. About 0.02% of the human body is made of lithium compounds.

Scientists have known that all living things contain lithium, but they are not completely sure what lithium does. Japanese and German scientists in 2011 found that adding lithium in the diet increases human life expectancy 👨‍👧👩‍👦, and American scientists have found that that towns in Texas where lithium is abundant in well water have lower rates of violent crimes.

How Lithium Is Used In Mental Health Care

A form of lithium known as lithium carbonate is used to treat bipolar affective disorder, which is formerly known in the psychiatry field as manic-depression. In bipolar affective disorder, the mood can swing from depressed to elated and back over long or short periods of time. 🧎 Lithium is very useful for smoothing out mood swings in bipolar disorder, especially euphoric mania that leaves the sufferer feeling good about wild or extreme actions. It has a specific anti-suicide effect that is not obtained from newer medications for the condition.

Lithium is not an easy drug to use. It has to be built up in the bloodstream over time.

It is not always possible to build up lithium levels fast enough to prevent a manic episode. About 50% of people who take lithium develop intense thirst, which dilutes the bloodstream and lowers the effective concentration of the lithium, making it less likely to work.

Up to 50% develop dry mouth, which can cause problems ranging from bad breath to tooth decay. Many people who take lithium develop hand tremors, involuntary batting of the eyelashes, memory lapses, confusion, nausea, vomiting, diarrhea, overreactive reflexes, and vertigo, all of which become less common over time. The complication that becomes more common over time, however, is acne.

Why Lithium May Cause Acne

Not everyone who takes lithium develops acne, but there are those who do. The reason lithium triggers acne is counterintuitive. It increases the activity of the immune system which in turn increases skin inflammation.

Lithium causes a condition called leukocytosis. 🩺 The technical definition of leukocytosis is an increase in white blood cell (WBC) count due to any cause. When people who have bipolar affective disorder take lithium, the drug causes them to produce more stress hormones (which is actually a good thing) when they are depressed. These stress hormones make it easier to find the energy to function day by day.

Stress hormones in the skin, however, increase inflammation.

They trigger the release of histamine from storage packets in the skin. Histamine is the same chemical that causes allergies. It breaks down skin cells or cells in the membranes lining the nose and throat to remove foreign bodies and germs. When the release of histamine is induced by stress, however, histamine destroys healthy tissue that has not been penetrated by foreign bodies or infected by germs. The result is redness, itching, and even pain in the skin that is worse in pores that are affected by acne.

Not Just From Medication

It isn’t just medications like lithium carbonate or Eskalith that can cause an excess of lithium to accumulate in the body. It’s also possible to accumulate lithium from food. Tomatoes and hot green peppers (especially jalapeños and serranos), the main ingredients in pico de gallo and salsa, are rich in lithium. 🍅 When eating too much salsa or pico de gallo makes the skin break out, it’s not necessarily an allergic reaction. It can be a reaction to lithium in the food, especially if the tomatoes or peppers were irrigated with high-lithium water such as is found in Arizona, New Mexico, and far western Texas in the United States.

What To Do When Lithium Causes Acne Outbreaks

If you take lithium and your face breaks out, the last thing you should do is to stop taking your medication. It also won’t help to use skin disinfectants or pore cleansers, unless you happen also to have the common form of acne known as acne vulgaris. What you need to do is to reduce the amount of inflammation in your skin as best you can.

It usually helps to limit or eliminate consumption of hot peppers, tomatoes, and potatoes that may be high in lithium. It also helps, as we have mentioned elsewhere on this site, to take a probiotic like Lactobacillus acidophilous.

Probiotic supplements deliver more of the friendly bacteria to your small intestine than yogurt, and yogurt is only helpful if it contains live bacteria.

Some “probiotic” yogurts don’t contain live bacteria, and among the brands of yogurt sold in the USA and Canada that aren’t sold as probiotic supplements, only Stonyfield Farms and Oikos are actually helpful.

The reason probiotic bacteria help compensate for the effects of lithium is that they “train” the immune system to release less inflammation. When the immune system first encounters friendly bacteria in the small intestine, it treats them as if they could cause disease. It releases inflammation to kill probiotic bacteria.

If you are eating yogurt with live cultures or taking a probiotic supplement, however, your immune system can’t get them all. 🥄 Eventually it learns that fighting probiotic bacteria is not necessary. Some of the cells that are “trained” in the small intestine circulate through the bloodstream to the skin, where they are less likely to release inflammation when they encounter acne bacteria.

If you take lithium and live in a town in the USA or Australia that has high concentrations of lithium in drinking water, it also helps to drink bottled water. 💧 You can save money by buying 5-gallon (20 liter) containers. Reducing the amount of lithium in food and drink and increasing the activity of probiotic bacteria helps clear up acne without interfering with essential medical treatment.