A 23 year old normotensive, euthyroid male who is diagnosed as a case of Mania with Psychotic symptoms (1st episode) was well managed with Lithium Carbonate SR 1000mg/ day and Olanzapine 15 mg/ day which resulted in adequate symptom control. He returned to follow-up with a breakthrough manic episode during which lithium was increased to 1200mg/day with adequate within-range serum lithium levels. A third follow up showed adequate symptom control but now the person presented with small papular lesions on his forehead and on his both cheeks (see pic). Lithium is known to cause acneiform skin lesions.
What to do in such a case? Apart from the skin lesions, he is well maintained with this dose of lithium. Please opine.
