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Helping People Achieve Clear Skin Since 2007

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.

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FatBat Reply

Thank God I finally found a website that is anti-lithium! Every one else acts like lithium is oh-so-totally-awesome. It's not! Lithium is a horrible poison that causes kidney and thyroid damage. Lithium = dialysis!

August 2, 2013 at 12:31 am Reply
Binary Reply

I wouldn't say that this site is anti-lithium. Not everything about lithium is perfect but for some people is very necessary. There's no arguing that lithium doesn't cause acne, or that it isn't dehydrating (it's a salt, so of course it is) but for those who suffer from severe bipolar disorder if you monitor it carefully it can be tremendously helpful in modulating symptoms (which can, for some, be quite deadly). Just like consuming too much of most compounds can be deadly, too much lithium is deadly, but in healthy, low amounts it's just fine for anyone.

December 8, 2013 at 1:15 am Reply
George Reply

For most people these medications are the better of two evils. Many people who need these things know there isn't a cure, and would gladly trade a little physical health (see side effects) for a great gain in mental health.

September 11, 2014 at 2:23 am Reply
Amy Reply

Lithium is a miracle drug for me, though it does have some bad side effects. I have the hand tremors and the thirst, and since my dose has been raised, acne. But I suppose this is better than the alternative. I just wish I knew how to stop the acne, it doesn't help my self esteem and sometimes, is quite embarrassing. But again, better than being suicidal or crazy manic.

January 15, 2014 at 4:02 am Reply
George Reply

You and me both Amy. Remembering how it was pre-medication puts it all in perspective, although with lithium you'd want to go get your levels checked if you think something is off.

September 11, 2014 at 2:28 am Reply
Michael Reply

I am the lucky one. Lithium for 3 years without a single side-effect and no mania whatsoever. My daughter inherited my bipolar brain, and she too is greatly helped by lithium. Unfortunately, she gets BAD acne and has to take a thyroid medication. It is like a deal with the devil. damned if you do, but even more damned if you don't. Does anyone have any secret remedies to relieve the inflamation?

March 21, 2014 at 2:27 am Reply
Sanjeet Reply

Taking Lithium for 5 years now. The side effects are significantly reduced over a long period of time. The only challenge is some random outbursts of acne. It can be helped by keeping skin clean and dry by frequent face wash. Increasing water intake helps as well. I have noticed that reduction in coffee intake helps as well. All you fighting with bi-polar - its a war and we win with Lithium! Acne is your glory scar! ;)

June 4, 2014 at 7:24 pm Reply
Tracy Reply

Lithium has been a life saver for me. I suffered terrible bipolar symptoms that no other meds could help. The down side is I have hand tremors and bad acne. At 46, the acne really bothers me and has affected my self esteem. I would just like an effective treatment for the acne.

June 26, 2014 at 2:12 am Reply
maura adams Reply

Hi be very careful with lithium. My son got a kidney infection and his levels were toxic. But Im writing this to tell everyone to google vit D 3 Dr Horlick and Dr Canell They now know vit D is not a vitiamin but a steroid hormone and it is needed by every cell including the brain. it is a nuron protector. My son took a thyroid problem and thay were going to put him on thyroxine but i had him on D3 and just before starting thyroixine the blood test showed his thyroid levels normal. so please everyone google u tube vit d 3

July 14, 2014 at 10:24 am Reply
mary Reply

dear author I'm student of pharmacy and I want to cite your article in a study about lithium induced skin problems. would you please tell me that this article is based on your experience or is according to some thing else? it is difficult for me to find articles on this topic, because most of them are just abstract. could you please help me for this? tx:) best regard

November 19, 2014 at 6:01 pm Reply
G Reply

Yes, please let us know some more about this information. I would love to know more.

February 27, 2017 at 8:09 am Reply
Michele Reply

How quickly after starting lithium can you start to develop the acne? I have only been on it for 4 days and I'm just trying to know when to be on the look out. I already get some break outs and am not sure if I should will notice it getting more severe if I start to develop this specific side effect.

September 7, 2015 at 7:12 pm Reply
kjoy Reply

What a great article. Thank you so much for explaining all that! So hard to find information so useful about lithium. I have been taking lithium for about two years and It has been a miracle drug. However I have struggled on and off with acne. Recently I lowered my dose because of intense itching and thirst. Since then my thirst has gone down but, my acne flarred up outrageously. Never been so bad with pustules impossible to hide. My doctor says I am a textbook copy of someone who needs to go on accutane. What are your thoughts on Accutane for the worst cases? Also does lithium effect gastrointestinal issues and can lithium cause food allergies. And another question about lithium in water supplies, do water filters like brita help? Thanks so much. Scheduled to start Accutane in a week. Seems like the last option but will be monitoring my mood closely. All the best. Kjoy

December 14, 2015 at 4:09 am Reply
Jennifer Reply

Accutane causes depression in some people.

March 22, 2016 at 4:07 pm Reply
Anne Reply

I was diagnosed with bi polar 1 at age 18, was on Lithium for a year, and I got terrible acne. My dr. did not inform me at that time that acne and weight gain were side effects of lithium. My face was a mess and I gained weight (lots of emotional overeating too though). I went on Accutane twice, since the first time didn't seem to clear it up completely. It worked and now at age 53, I actually receive a fair number of compliments on my skin. It is pretty smooth and I don't have many wrinkles but because I always had oily skin, I will be susceptible to acne until the day I die. I recently started taking lithium again (less than a week ago) to treat recurring bi polar symptoms which were brought on by work stress. The one thing is that Accutane left me with sensitive skin for the rest of my life. It did work though and I recommend it if nothing else works. I only get very small breakouts now and then if I eat a lot of chocolate. I can easily control them with a topical cream like Benzagel.

February 12, 2017 at 3:49 pm Reply
Mel Reply

I had a seizure on lithium which meant I couldnt drive for 3 months. I have severe acne, hand tremors, thirst. I wouldn't recommend to anyone. My lithium was at a toxic level and psych was lazy in reducing my medication... Which resulted in seizure. My self-esteem is so low from the side effects of lithium and serequel that I honestly am considering coming completely off the medication as soon as possible by reducing my dose every week. I hope to be off my medication in less than 3 months.

February 1, 2017 at 7:13 am Reply
Amber Reply

I was on that same combo, and I would sleep like the dead and always tired, we took away the seroquel and lowered my lithium, then tried lithium spread out 3x a day, now we switched to the slow releaSe lithium and take just once daily, 4x 300mg slow release now helps, less hypomanic, no manic, depression was coming back but seems stable, am less tired, but yup still got that acne, hope everything worked out. Sounds like you just need a new med doc, mine constantly runs my lithium levels, and kidney functions, and we play around with how much I need or not. And soooo glad I got off the seroquel, both meds caused me to gain, 35 lbs, but lost 10lbs fast once seroquel was dropped, I think that extra weight from seroquel was the non stop sleeping. As for the acne, it is driving me insane, but I'd rather have sanity. I say the price I'm paying, a BIG butt and a pizza face is a good cost for being the most normal I've been in years on so many other meds.

August 19, 2017 at 10:14 am Reply
Amber Reply

I'm going to try acidophilus anyhow, my mom recommends it for everything as is! So wish me luck, I should be taking it daily anyhow!

August 19, 2017 at 10:17 am Reply
Ami Reply

I have been battling with acne for about a 2 yrs after starting lithium. I take a probiotic ( ultimate flora 150 billion) once a day. I also use manuka honey on my face every night before bed. I am seeing a big difference in my face and the size of the pustules with continued use.

March 25, 2019 at 3:09 am Reply