International Journal of Trichology

: 2015  |  Volume : 7  |  Issue : 1  |  Page : 1-

Lithium in trichology: A double edged weapon

Patrick Yesudian 
 President, The Hair Research Society of India, No. 10, Ritherdon Avenue, Vepery, Chennai - 600 007, Tamil Nadu, India

Correspondence Address:
Patrick Yesudian
President, The Hair Research Society of India, No. 10, Ritherdon Avenue, Vepery, Chennai - 600 007, Tamil Nadu

How to cite this article:
Yesudian P. Lithium in trichology: A double edged weapon.Int J Trichol 2015;7:1-1

How to cite this URL:
Yesudian P. Lithium in trichology: A double edged weapon. Int J Trichol [serial online] 2015 [cited 2023 Jan 29 ];7:1-1
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Much has been written in these columns about the influence of mind on hair disorders, the so called psychotrichology conditions such as alopecia areata; diffuse hair loss, Trichotillomania and many others have a putative origin in the brain probably acting via the psycho-neuro-endocrine-immuno-cutaneous pathway. Hair loss can lead to profound depression to bipolar illness.

A very useful drug for the treatment and the prophylaxis of the latter is lithium. Though first discovered in 1818 by Johan August Arfvedson [Figure 1], it was used in clinical medicine only in 1843 by Alexander Ure for treating uric acid bladder stones. William Hammonds [Figure 2] was the first to use the drug in 1873 for the treatment of maniac episodes. In larger than pharmacological doses it did cause a few deaths and hence, like thalidomide it was consigned to the realms of medical history. However, after intense research, the drug was approved in 1970 for the treatment and prophylaxis of bipolar illness.{Figure 1}{Figure 2}

Callaway et al. (1968) were the first to report cutaneous side effects such as pruritus and skin ulcers. Subsequently, many other skin side effects have been recorded, the most familiar ones being exacerbation of psoriasis and acne, possibly by decreasing the levels of the second messenger cyclic adenosine monophosphate.

From a trichologist's viewpoint hair, loss is the most common side effect of lithium even when it is in the therapeutic levels in the blood. The anagen effluvium occurs in a few days to weeks while the telogen effluvium may take a few months to develop. Alopecia areata or disorders of texture like dry and brittle hairs may also occur.

Before blaming lithium as the cause of alopecia, one should exclude hypothyroidism, a well-known side effect of lithium and also the psychological stress for which the drug was given in the first place. If the hair loss is causing a lot of concern to the patient, then the drug may have to be withdrawn in consultation with the psychiatrist.

Folliculitis may also be associated with lithium intake. This may be asymptomatic or associated with itching. No treatment is required other than antihistamines for the pruritus since the condition resolves even if lithium is continued. It is possibly due to excretion of the drug through sweat causing irritation to the hair follicles in the early stages of drug intake until a steady state of the drug level is reached in the blood.