If you haven’t, then it’s almost guaranteed that you are about to.
Out of the countless medications for blood pressure, anxiety and depression and other diseases dished out by doctors, few have the reputation of lithium. Physicians proscribing lithium to patients with bipolar disorder even warn against acne.
Endless patients on the internet have formulated theories about lithium’s connection to acne. Some speculate that the same neurotransmitters which lithium uses to enhance the mood and banish depression can also stimulate the sebaceous glands and increase oil production.
Another theory is that lithium uses stress hormones to increase energy production, hence increasing acne as well. Most of those theories are nonsense.
The truth is that lithium carbonate does trigger acne, and there is a little known but extremely clear cut reason which explains why.
What is lithium – is it some faceless drug?
Lithium isn’t a random harsh chemical invented by pharmaceutical companies. It’s a natural mineral on planet earth which naturally constitutes 0.02% of the human body. Animals and plants close to the ocean are especially rich in lithium.
Lithium isn’t the brain equivalent of sodium fluoride in toothpaste, an unnatural chemical that achieves the goal but destroys the body. Dietary lithium has been shown to increase life expectancy in Japan. Certain towns in Texas and Arizona have dramatically lower crime rates because of high lithium levels in the drinking water.
Some scientists with good but misguided intentions are even plotting to add it to all drinking water. Conspiracy theorists claim that this is a government scheme to keep us happy, dumb and obedient.
On the other hand, you have to control the lithium dosage for weeks to slowly build up levels in the bloodstream. There are side effects other than acne and the most common include a dry mouth, hand tremors, confusion, memory lapses and nausea.
Dietary lithium is safe. Lithium taken at levels required to alter neurotransmitters is another story.
THE PROOF – people aren’t imagining acne
If you’ve observed an outbreak in pimples after jumping aboard the lithium train then you were absolutely correct. It wasn’t a daily glass of orange juice which you started drinking during the same period, it wasn’t an herbal supplement you began taking, even though such factors could have made a difference.
Lithium is pretty much proven to cause acne. Look at the following studies:
STUDY ONE – our first exhibit is a case study of a 40 year old woman entering her 5th month of taking lithium. She hadn’t experienced any significant acne in her lifetime previously, but she now had a severe eruption of papules, nodules, and cysts, in addition to several comedones on her face.
The scientists observed this outbreak of acne and immediately switched her to a new bipolar medication. Six months after the switch, the outbreak had improved. 9 months after abandoning the lithium, the acne had cleared entirely.
STUDY TWO – this review of lithium’s side effects commented that lithium led to more reactions compared to other psychotropic medications, and particularly acne and psoriasis. The occurrence of acne was claimed to be as high as 45%.
STUDY THREE – instead of the normal acne vulgaris, this study detected the hardcore form of acne called acne conglobata. This vicious disease is characterised by pimples but also burrowing and connecting abscesses.
A lithium patient aged 30 was found to have the disease; to start with he was given corticoids and a topical retinoid cream twice daily. This failed to improve the acne after 7 days, so they discontinued the lithium medication and this led to a significant reduction in symptoms after just two weeks.
According to the scientists, acne conglobata is a rare side effect of lithium and has only been detected four times. More common reactions to lithium were said to be psoriasis, folliculitis, and acne vulgaris.
STUDY FOUR – this study documented a tale which might have happened to you, or may happen to you in the future. A 26 year-old woman was brought in suffering from acneiform eruptions, which turned out to actually be folliculitis rather than true acne.
The outbreak lasted for six months, but vanished three months after the lithium medication was discontinued. The pimples did not resurface over the next three years.
If you’re taking lithium to treat bipolar disorder then you are highly likely to experience acne, psoriasis, or some form of inflammatory skin condition.
In study one, the average occurrence of skin conditions in bipolar disorder patients taking lithium was estimated to be 3-45%. The average lithium patient experiences heavy papulopustular acne (pimples) and few cysts and whiteheads; the 40 year old woman above was a rare exception.
It’s also possible that you don’t have the garden variety acne vulgaris at all; you may have the severe acne conglobata. The same goes for psoriasis, a skin disease characterised by red, flaky, crusty patches of skin. Skin conditions unrelated to acne have been observed as well, such as red rashes, dermatitis, and eczema.
For acne, the first six months are the danger zone; that’s what the statistics say. On the ground however, some acne patients report in with never-ending outbreaks from lithium lasting for years, saying that they accept it and would rather keep their brain working properly. Luckily, you don’t have to accept it.
THE EXPLANATION – lithium increases neutrophil levels
With almost all lithium patients scratching their heads and running around in a wild goose chase, it takes a fair amount of research to discover the real connection to acne. Lithium elevates your bodily levels of pro-inflammatory chemicals called neutrophils.
Neutrophils are types of white blood cells which travel to wounds and generate a “respiratory burst”, or oxidative burst. They fire a cluster of free radical types called superoxides, both to 1) destroy microbes which infect the wound and 2) break down dying tissue in order to replace it.
Without neutrophils you’d be dead – every human needs them. However, elevated levels of neutrophils (neutrophilia) results in massive free radical damage to the skin, inflamed pimples, and even more acne. Chronic inflammation is the root cause of acne and neutrophils are one of the chief chemicals involved.
Neutrophils are the real reason why lithium medications can increase acne. Lithium has been shown time and time again to increase neutrophil levels in the blood.
STUDY ONE – this study analysed lithium in the concentrations used for mood enhancement in psychiatric medicine. Lithium was found to cause elevated neutrophil concentrations (neutrophilia) and it acted by stimulating a pathway called CXCL12.
STUDY TWO – our second piece of evidence, meanwhile, is a case study of a 40 year old Sri Lankan man. He had developed neutropenia, chronically low levels of neutrophils, and his immune system was compromised.
Hence, the scientists fed him lithium carbonate, and the neutrophil levels quickly corrected themselves. The conclusion: “lithium carbonate can successfully be used to treat clozapine-induced neutropenia”.
STUDY THREE – this old 1978 study tested the effect of lithium on neutrophil mass and neutrophil production in 12 patients. By the conclusion, the median neutrophil concentration of the lithium group was significantly higher than that of the control group.
Most importantly, migration of neutrophils into skin cells increased significantly. The rate was 34 to 469 x 10(5) cells per day in the lithium-treated patients compared to 1.7 to 68 x 10(5) in the 10 controls. That’s a pretty massive increase.
A high lithium intake correlates very closely with sky-high neutrophil counts which are way beyond healthy human functioning.
To put the last nail in the coffin we have a study analysing neutrophil levels in acne patients. It was found that acne patients had very low levels of linoleic acid in their skin, and since linoleic acid inhibits neutrophil activity, their neutrophil counts were higher. Furthermore, the neutrophils in the skin of acne patients behaved differently, generating higher quantities of free radicals.
There you have it. Lithium medication causes acne by increasing one of the most powerful pro-inflammatory chemicals in human skin.
The connection to stress hormones
The widespread theory about lithium causing oily skin via neurotransmitter alterations is completely false; there’s not a shred of evidence to support it. However, the stress-related theory is more substantiated if still unproven.
Here’s the theory – lithium causes the adrenal glands to manufacture more stress hormones such as cortisol. This increases the glucose levels in the blood and other forms of flight or fight style energy and allows bipolar patients to function more effectively. Stress causes acne, which is completely true.
Firstly, an increase in stress hormones is not proven to be behind lithium’s psychiatric benefits. Lithium’s exact mechanisms are mysterious, but serotonin plays a much bigger role.
Nevertheless, there is some evidence that lithium increases stress hormones:
STUDY ONE – 30 patients with depression were given lithium medication for 4 weeks in this study. The lithium increased rapidly to the optimal blood level for treating psychiatric problems. The two stress hormones cortisol and ACTH both increased substantially after 28 days. This only occurred in the patients whose depression responded to the lithium; in the non-responders there was no increase.
STUDY TWO – this study, meanwhile, observed no increase in cortisol at all. In fact, cortisol levels fell, among 53 depressed patients given lithium. The study was conducted for an entire year as well.
STUDY THREE – this study was almost identical to the first one. 24 patients with major depression were given lithium and their cortisol and ACTH levels increased. The only difference was that cortisol levels increased in both the lithium responders and the non-responders.
Factor in a few studies elsewhere and there’s decent evidence that lithium can increase cortisol levels, but the neutrophils easily remain as the biggest culprit behind acne.
The only other significant result of lithium medication is hyperkeratosis. There’s less studies, but still newly emerging evidence that lithium accelerates the production of keratin. That’s a protein which binds dead skin cells together into giant clumps and is a seriously overlooked acne villain.
Lithium could therefore increase clogged pores as well as inflammation. However, the case study on the 40 year old woman mentioned how most acne caused by lithium is inflammatory in nature. That again suggests that the neutrophils are the biggest factor.
FACT – bipolar disorder doesn’t doom you to acne
The one fact which isn’t up for debate is that lithium works as a bipolar disorder medication. If you’ve stumbled across this article, then you probably want a strategy to allow you to use lithium while keeping your skin clear.
Luckily, neither stress hormones nor neutrophils are important for the psychiatric effects, so you can wipe them out while still achieving the brain benefits you want.
The “happiness hormone” is the key. It’s theorised that lithium acts on receptors in serotonin-sending cells to allow more serotonin to be transferred from one brain cell to another. Lithium is believed to enhance the ability of brain cells to receive serotonin molecules, and block the serotonin transporter protein which removes excess serotonin from synapses between brain cells.
All these theories were calculated using animal research. I’m no expert on bipolar disorder but I’d seriously doubt that cortisol is the main factor. It’s far too complicated a condition for a rudimentary increase in glucose metabolism to improve it so strongly; the same goes for manic depression. Serotonin and other subtle alterations in neurotransmitters are almost certainly behind lithium’s benefits.
If you’re taking lithium, then your objectives are to 1) prevent the acne from neutrophils and 2) prevent the stress hormones from causing acne.
Neutrophils cause acne by increasing inflammation and local free radical generation. Therefore you need to focus hard on anti-inflammatory strategies, such as reducing your sugar intake or your dairy consumption if you have a sensitivity.
This article on the top 18 foods for lowering inflammation is a great place to start. Stick to anti-inflammatory topical treatments rather than antibacterial ones or topical treatments which reduce oily skin. Examples include aloe vera and witch hazel. Rose water has actually been proven to inhibit neutrophils specifically, in this study and this study.
For stress, vitamin C is your best friend. Megadose with vitamin C and you can keep your cortisol levels low. The daily allowance for vitamin C is 60mg but up to 2000mg is safe in times of stress, because the molecules get depleted by deactivating excess cortisol molecules.
Magnesium can prevent elevated stress hormones as well, and up to 80% of the US population is deficient in it. Raspberries are rich in a compound called rutin which lowers stress. Pomegranates contain antioxidants which inhibit the conversion of the inactive cortisone to the more active cortisol.
You have learnt all you need to know. Lithium is proven to cause acne, it causes acne by increasing neutrophil activity and consequently inflammation, and there are several strategies for circumventing the acne.
A final strategy would be to lower the dosage of your lithium slightly. You’d reduce the bipolar benefits, but if lithium’s psychiatric effects are down to serotonin alteration, you can make up for the loss elsewhere.
For example, you can eat dark chocolate, and get more magnesium and zinc to increase the construction of serotonin in the first place. You can eat more antioxidants to protect serotonin molecules from damage.
If you want to take a risk, then try this strategy and your acne might fade away, while keeping your brain function roughly the same.
Thanks for reading!