The Reason Why Lithium Causes Acne (And The Secret Solutions)

If you’re taking the gold standard of bipolar disorder medications lithium carbonate, then you’ve probably experienced the side effect of acne. 

If you haven’t, then it’s almost guaranteed that you are about to.

Out of the countless medications for blood pressure, anxiety 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.

There’s endless theories on the internet, including that the same neurotransmitters which lithium uses to banish depression can also stimulate the sebaceous glands and increase oil production. Others speculate 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 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.

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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.

More negatively, patients have to control the lithium dosage for many long weeks, to slowly increase bloodstream levels. 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 harmless for acne. Lithium taken at levels required to alter neurotransmitters is another story.

 

THE PROOF – people aren’t imagining acne

ONE – our first exhibit is a 40 year old woman entering her 5^th month of taking lithium (study). 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 immediately switched her to a new bipolar medication, and six months later, the outbreak had significantly improved. 9 months after abandoning the lithium, the acne had cleared entirely.

TWO – this review of lithium’s side effects detected more reactions compared to other psychotropic medications, and particularly acne and psoriasis. The occurrence of acne was claimed to be as high as 45%.

Vital reading: the top 6 vitamins and minerals for radiant and clear skin

THREE – instead of the normal acne vulgaris, this study detected the hardcore form of acne conglobata, in a lithium patient aged 30. This vicious disease is characterised by pimples, but also burrowing and connecting abscesses.

To start with, he was given corticoids and a topical retinoid cream twice daily. This didn’t achieve anything after 7 days, so they discontinued the lithium medication, causing the acne to retreat significantly 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 were said to be psoriasis, folliculitis, and acne vulgaris.

STUDY FOUR – this study followed a 26 year old woman suffering from acneiform eruptions, which actually turned out to be folliculitis rather than true acne.

The outbreak lasted for six months, but vanished after three months when the lithium medication was discontinued. The pimples did not resurface over the next three years.

If you’ve ever noticed an explosion of pimples after jumping aboard the lithium train, then you were absolutely correct. 

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, and the answer is neutrophils.

Neutrophils are a type of white blood cell which travel to wounds and generate a “respiratory burst”. They unleash a cloud of free radicals called superoxides, in order to 1) destroy infectious microbes, and 2) break down dying tissue in order to replace it.

Without neutrophils you’d be dead – every human needs them. However, massively elevated levels (AKA neutrophilia) result in 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.

ONE – this study analysed lithium in the standard concentrations used for mood enhancement. The medicine significantly increased neutrophil concentrations, and it acted by stimulating a pathway called CXCL12.

TWO – our second piece of evidence 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 his neutrophil levels rapidly corrected themselves. The conclusion: “lithium carbonate can successfully be used to treat clozapine-induced neutropenia”. The scientists weren’t thinking about acne, but we’ll greedily use this as evidence.

THREE – this old 1978 study gave lithium to 12 patients, and by experiment’s end, median neutrophil concentrations were significantly higher compared to the control group.

Most importantly for us, migration of neutrophils into skin cells increased significantly. The rate was 34 to 469 x 10(5) cells per day compared to 1.7 to 68 x 10(5) in the 10 control patients. That’s a pretty massive increase.

Lithium has been shown time and time again to increase neutrophil levels in the blood.

To solidify the connection, we have a study on acne patients, where neutrophils were significantly higher than average. The neutrophils in acne-prone skin even behaved differently, generating higher quantities of free radicals.

 

The connection to stress hormones

The widespread theory about lithium causing oily skin via neurotransmitters is completely false; there’s not a shred of evidence to support it. However, the stress-related theory is much more substantiated.

Here’s the theory – lithium triggers the adrenal glands to manufacture more stress hormones such as cortisol. This gives bipolar patients a new leash of life, by summoning flight or fight energy in the form of glucose, but the side effect of the stress hormones is acne (a connection which is completely real).

First of all, stress hormones are not proven to be behind lithium’s psychiatric benefits, as serotonin plays a much bigger role.

Nevertheless, the evidence that lithium increases stress hormones is decent: 

ONE – 30 patients with depression were given lithium medication for 28 days (study). Lithium increased rapidly in the bloodstream, and so did the stress hormones cortisol and ACTH. This only occurred in the patients whose depression responded to the lithium; in the non-responders there was no increase. 

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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. 

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 rose both in lithium responders and non-responders.  

The stress power seems to exist in certain circumstances, and the only other confirmed danger of lithium for acne is hyperkeratosis. That’s when the skin protein keratin increases to extreme levels, and glues dead skin cells together into giant clumps which block your pores.

Keratin is a highly overlooked acne villain, but that said, the case study on the 40 year old woman mentioned how most lithium acne is inflammatory in nature. The evidence points to neutrophils being the main player.

 

FACT – bipolar disorder doesn’t doom you to acne

The one fact which we’re not debating is lithium’s effectiveness as a bipolar disorder medication. Scientists are still debating the causes, but the “happiness hormone” serotonin is probably the key. It’s theorised that lithium enhances the ability of brain cells to receive serotonin molecules, and blocks 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.

It’s almost certainly serotonin and other neurotransmitters, and the good news for you? It means that the neutrophils and stress increase have nothing to do with the psychiatric benefits, and you can still wipe them out while achieving the brain benefits you want. 

Neutrophils unleash their acne consequences via inflammation and 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 remedies 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. 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. 500mg would be sensible.

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.

 

Conclusion

You’ve learnt all you need to know. Lithium is proven to cause acne, it causes acne by increasing inflammatory neutrophils, and there are several strategies for avoiding this.

A final strategy would be lowering the dosage slightly. You’d reduce the bipolar benefits, but if lithium’s psychiatric effects are down to serotonin alteration, then 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. Note that I’m not a doctor, and you should always follow your own doctor’s medical advice. 

Remember – lithium is far from an acne death sentence. 

NEXT: get the full skin-clearing diet and wave acne goodbye forever

 

 

 

Thanks for reading!