Rash and Inflammation While on Lamictal

Lamictal (lamotrigine) is an anticonvulsive drug frequently used as a mood stabilizer for people living with bipolar disorder. It works by moderating extreme variations in mood and is particularly helpful in treating severe depression.

Since its introduction in 1994, the medication has enjoyed widespread use. Today, it is on the World Health Organization's List of Essential Medications.

Despite its proven benefits, Lamictal has its downsides. In some individuals, Lamictal has been known to cause a hypersensitivity reaction marked by severe rash and inflammation. This finding led the U.S. Food and Drug Administration (FDA) to issue a black box warning advising consumers about this rare but potentially deadly reaction.

Symptoms of Lamictal Rash

There are a number of early-onset symptoms that might indicate that you are having an allergic reaction to Lamictal. Some of these include:

• Feeling poorly
• Fever
• Itching skin
• Hives
• Red blisters on areas of the body, which may include the face or mouth

The symptoms can range from benign to potentially fatal. However, there is no way to gauge the potential outcome based on the symptoms. If you experience any signs of a rash when taking Lamictal, even if it seems mild, you need to contact your doctor immediately.

Hypersensitivity Reactions

The FDA warns that people who take Lamictal may experience a number of hypersensitivity reactions. A hypersensitive reaction occurs when a condition or drug causes the immune system to overreact, resulting in an allergy or adverse autoimmune response.

With Lamictal, these can include reactions known as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reactions with eosinophilia and systemic symptoms (DRESS syndrome).

Each of these conditions manifests with a severe (some say "angry") rash, which typically develops after two to eight weeks of drug use. Mortality rates are significant, ranging from 5% to as high as 30%.

Stevens-Johnson Syndrome

Stevens-Johnson syndrome (SJS) can often be preceded by flu-like symptoms such as:

• Cough
• Diarrhea
• Fever
• Headache
  
• Sore throat
  
• Vomiting

This can be followed by an all-body reaction characterized by a quickly spreading rash, swelling of the face and tongue, and the severe blistering of the mucous membranes of the mouth, nose, and eyes.

Toxic Epidermal Necrolysis

Toxic epidermal necrolysis (TEN) is essentially SJS but worse. TEN involves the detachment of more than 30% of skin, as opposed to SJS, which involves less than 10%. Moreover, the risk of death from TEN is between four and five times greater than that from SJS.

DRESS Syndrome

DRESS syndrome is a drug reaction that can also cause rash alongside other characteristic symptoms, including severe nerve pain and inflammation of at least one major organ (most often the liver, kidneys, lungs, heart, muscles, or pancreas).

Causes of Hypersensitivity

By and large, people under age 17 are more likely to have a reaction to Lamictal than adults. In addition, several factors can increase the likelihood of an adverse response:

• Taking more than the recommended dose when starting therapy
• Increasing the dose too quickly when starting instead of ramping up gradually
• Stopping treatment and starting again at the normal full dose
• Taking the medications Depakene (valproic acid) or Depakote (sodium valproate) in conjunction with Lamictal

It should be pointed out, however, that hypersensitivity can sometimes occur even if you are taking the drug as prescribed. While genetic factors appear to play a part, the causes are occasionally idiopathic (meaning we simply don't know the reason).

It is important to note, however, that not all hypersensitivity reactions will result in SJS. Putting it all into perspective, there is only a 0.1% chance of such an event occurring.

In the end, the severity of the reaction, as well as the availability of other mood-stabilizing drugs, informed the FDA decision as much as the statistical risk itself.

Treatment for Lamictal Rash

Treatment involves the immediate discontinuation of Lamictal and using supportive therapies to treat the pain, prevent infection, and ensure that the person remains properly hydrated.

The skin damage is treated in a similar manner to a thermal burn. Corticosteroids are commonly used to reduce inflammation.

• For mild rashes, a healthcare professional might recommend monitoring the symptoms and using topical creams and ibuprofen to minimize pain, reduce inflammation, and prevent infection. 
• Stevens-Johnson syndrome treatment involves hospitalization and supportive care to manage symptoms.
• Toxic epidermal necrolysis also requires hospitalization and may require the administration of fluids, intravenous antibiotics, and/or immune therapy.
• DRESS syndrome may require hospitalization, depending on the severity of the condition. Other treatments may be needed if they experience other complications, such as liver or kidney failure.

If a person is required to stop taking Lamictal, their doctor may recommend a different mood stabilizer such as Depakote (divalproex sodium, sodium valproate, and valproic acid), lithium, or Topamax (topiramate). Research also suggests that Zyprexa (olanzapine) can help manage symptoms of bipolar disorder.