Lityumla ortaya çıkan iki psöriyazis olgusu

Lityum iki uçlu duygudurum bozukluğu tedavisinde başlıca tedavi seçeneklerindendir ve lityum tedavisi sırasında dermatolojik yan etkiler oldukça sık görülmektedir. Bu yan etkilerden en sık görülenleri akneiform döküntüler, folikülit, makülopapüler döküntüler ve psöriyazistir. Psöriyazis kronik gidişli inflamatuar bir deri hastalığı olup lityumun neden olduğu dermatolojik yan etkilerin başında gelir. Lityumla ortaya çıkan psöriyazis ve psöriyatik alevlenmeler oldukça sık görülen yan etkiler olmasına karşın, ortaya çıkış düzenekleri halen çok iyi anlaşılamamıştır. Ancak son dönemdeki çalışmalardan elde edilen kanıtlar lityumla ortaya çıkan psöriyazisin oluş düzeneğinin farklı olduğunu göstermektedir. Klasik psöriyazis oluşumunda proinflamatuar sitokinlerin artmış üretimi önemliyken, lityuma bağlı psöriyaziste bu düzenek daha az önemli görülmektedir. İn-vitro insan deri kültürlerinde, lityumun keratinosit proliferasyonu üzerine doğrudan uyarıcı etkisi olduğu bulunmuştur. Ayrıca, klasik psöriyazisli hastaların monositlerinde bazal proinflamatuar sitokin (IL-1β, TNF-α, IL-6) üretiminin arttığı görülmüşken, lityuma bağlı psöriyazisliler ve sağlıklı kontrollerde anlamlı artış saptanmamıştır. Bununla birlikte, in-vitro koşullarda lipopolisakkarid ile uyarılmış monositlerin bulunduğu ortama lityum klorür eklendiğinde, sağlıklı kişilerde ve lityuma bağlı psöriyazislilerde monositlerin IL-1beta ve TNF-alfa üretimi anlamlı olarak azalmışken, klasik psöriyazisli hastalarda anlamlı azalma olmamıştır. Bu bulgular ışığında, lityuma bağlı psöriyazis ve klasik psöriyazisin ortaya çıkış düzeneklerinin farklı olduğu söylenebilir. Ancak günümüzde bu farklılığı ortaya koyan yeterli veri bulunmamaktadır. Bu yazıda 41 yaşında, 12 yıllık hastalık öyküsü olup son 5 yıldır lityum tedavisi gören ve 35 yaşında, 13 yıllık hastalık öyküsü olup yaklaşık 11 yıldır lityum kullanan iki erkek hasta sunulmuştur. Bu olgu sunumu ile ‘lityuma bağlı psöriyazis’ fenomenine dikkat çekmek istemekteyiz.
Anahtar Kelimeler:

Lityum, Erişkin, Erkek, Psoriyazis

Two cases with lithium induced psoriasis

Lithium is the cornerstone treatment choice for bipolar disorder and its dermatological side effects are seen very often during the lithium treatment. These are usually acneiform lesions, folliculites, maculopapular eruptions and psoriasis. A well known side effect of lithium treatment is psoriasis which is a skin disease liable to chronic inflammation. Although psoriasis and psoriatic inflammations associated with lithium are widely seen side effects, the pathogeneses of lithium induced psoriasis and psoriatic inflammations are known very little yet. However, the findings obtained from recent studies show that immunopathogenic mechanism of lithium-induced psoriasis differs from that of regular psoriasis. An excessive production of pro-inflammatory cytokines as described for regular psoriasis is less likely to be an important pathogenic factor in lithium-induced psoriasis. Interestingly, direct stimulating effects of lithium have been found on the proliferation of keratinocytes in invitro-cultured normal human skin explants. Also, blood monocytes of patients with regular psoriasis showed an enhanced production of the pro-inflammatory cytokines (IL-1β, TNF-α, IL-6) when compared with the values found in healthy controls (HC) and patients with lithium-induced psoriasis (Li-Psor). Nevertheless, when LiCl was added in vitro to lipopolyride-stimulated monocytes, the production of IL-1β and TNF-α of HC and Li-Psor were significantly downregulated. This contrasted to monocytes of regular psoriasis patients, where Li2CO3 lacked a statistically significant dampening effect on the production of pro-inflammatory cytokines. These findings indicate that the pathogenesis of Li-Psor must be different from regular psoriasis. We have not enough data demonstrating the pathophsyological difference between Li-Psor and regular psoriasis yet. In this paper we report two cases that are being followed in our mood disorder outpatient unit, a 41 year-old man who has been treated with lithium 5 years in 12 years of bipolar disorder history and a 35 year-old man who was being followed up with 13 years of bipolar disorder history and on lithium prophylaxis about 11 years. Finally, in this case report we aim to attract attention to the phenomenon that lithium-induced psoriasis.
Keywords:

Lithium, Adult, Male, Psoriasis,

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