๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
Lithium
Lithium
Clinical features Lithium therapy is associated with cutaneous side effects in up to 45% of patients.1,2 It is known to precipitate or aggravate psoriasis, in particular, pustular lesions.3โ7 Other cutaneous adverse effects include maculopapular eruptions, seborrheic dermatitis, exfoliative dermatitis, atypical acneiform lesions (predominantly affecting the forearms and legs), pustular eruptions, hidradenitis suppurativa, keratosis pilaris-like lesions, palmoplantar hyperkeratosis, bullous disorders, and hair, nail, and mucosal changes.8โ13 Exacerbation and the development of Darier disease has rarely been documented.14
Clinical features Bismuth may be used for gastrointestinal complaints including gastritis and peptic ulceration.1โ3 Adverse cutaneous reactions include erythroderma, exanthemata, purpuric eruptions, stomatitis, urticaria, livedo-like dermatitis, pityriasis rosea-like dermatitis, allergic contact dermatitis to topical therapy containing bismuth.2โ6 Generalized pigmentation may follow prolonged parenteral and oral use. Patients develop a generalized blue-gray pigmentation, which also affects the conjunctivae and oral mucosa.1 A blue-black line at the gingival margin is pathognomonic.1 Transient black lingual pigmentation has also been reported.7
Histologic features Bismuth appears as small dark granules in the dermis and within sweat gland basement membranes.3 Transfollicular elimination has been documented.2