Antipsychotics and rashes

Common side effects of antipsychotic medications include antidopaminergic and anti-HAM (histaminic, adrenergic, muscarinic) effects.1 Antipsychotics’ antidopaminanergic side effects on the mesolimbic pathway are the therapeutic target; however, blockade of the nigrostriatum dopamine pathways causes extrapyramidal symptoms such as parkinsonism, akathisia, and dystonia.2 Extrapyramidal symptoms may range from distressing (e.g., torticollis) to life threatening (e.g., glossopharyngeal spasms).3 Dermatological exanthems induced by antipsychotic use is uncommon but a rare side effect that can be alarming to patients and can signal systemic reactions to the medications. The rashes associated with antipsychotic use are due to drug reactions and rashes due to injection sites. Rashes due to antipsychotic use that were reported in the literature are summarized in Table 1.4-20 In the psychiatric setting, rashes are most commonly associated with the mood stabilizer lamotrigine. However, it is important to realize the other skin manifestations after antipsychotic treatments. Discontinua tion of the offending drug is important after identification of a drug reaction. Topical and oral medications can help alleviate the pruritus and erythema; however, no longterm consequences have been noted from the rashes associated with antipsychotic use. We hope that by highlighting these dermatological side effects of antipsychotics will help with managing these occurrences in clinical practice. Mental Illness 2018; volume 10:7808