This 55 yo man
presents with a flare of Darier’s disease. In his own words, he suffers
from “mental illness” and has been on lithium for decades. He very
embarassed about his skin and feels that he looks “hideous” because of
this. Two yeas ago he had squamous cell carcinoma of the base of the
tongue that was treated with surgery, radiation and chemothreapy. This is in remission presently.
O/E: The examination shows widespread discrete and confluent reddish-brown greasy papules on the the chest and back.
We have treated him successfully with isotretinoin in the past and were concerned about the possible interaction between lithium and isotretinoin, but the patient is at his wits end with his disease.
PLAN: He was requalified for iPledge today. He will be started on 40 mg of isotretinoin a day. In a month, we will do biochemistry survey, CBC, lipid profile, and lithium level. We will obtain his last lithium level, in addition.
The patient was treated with 40 mg of isotretinoin daily. After a few months, he is completely clear and his dosage is being tapered.
References
Isotretinoin treatment of Darier's disease.
J Am Acad Dermatol. 1982 Apr;6(4 Pt 2 Suppl):721-6.
Dicken CH, et, al.
J Am Acad Dermatol. 1982 Apr;6(4 Pt 2 Suppl):721-6.
Dicken CH, et, al.
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