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.
J Am Acad Dermatol. 1982 Apr;6(4 Pt 2 Suppl):721-6.
Dicken CH, et, al.