Lamictal and acne

Red writes in with a common complaint about Lamictal . . .

I’m a 29 y/o female. I started Lamictal July of 07 (150mgs) and since then I have developed horrible acne along my jawline that takes weeks to clear up and new pimples develop every other day. They are painful. I also have pimples on my chest. I’ve never had bad skin in my life. I also noticed that I have more peach fuzz on the sides of my face and the hair on my head seems to be thinning as well. This really sucks for me because the Lamictal is the first thing that has helped to get me out of depression. Im also taking Lexapro 10mgs. I want to get off the Lamictal to see if these nasty side effects subside, but Im also scared to be on an emotional roller coaster again. I stopped birth control (Yaz) about 7 months ago and thought that if I start back on it again, it may help with the acne? It is supposed to be FDA approved for bc, acne, and PMDD symptoms, so maybe my answer lies in that. Before making my decision to stop the lamictal, I’ll see my Pdoc and my dermatologist. Mental health issues are a big pain in the butt to deal with!!!!!!

With the huge increase in use of Lamictal comes the inevitable huge increase in complaints about Lamictal.  No . . . nothing can ever be easy!  For most folks who take it, Lamictalis wonderfully helpful and has minimal side effects.  Acne, as described above, is one of the more common complaints for those who do experience difficulties.  It then leaves you with the dilemma of choosing whether you feel good . . . or look good.  Most people choose to look good.  More on that in another blarticle.  From your description of your situation, there are a number of options available for you. 

1.  Birth Control Pills–As you mention, some of the newer birth control agents can be helpful for a variety of issues.  As with mental health medicines . . . it is always a bit of a guess . . . might help . . . might not . . . won’t know till you try.  If you were on it before and it was helpful, it is certainly worth a try.  Especially if your acne only emerged after you stopped the Yaz. 

2.  Don’t stop the Lamictal . . . just lower the dose–The dose of Lamictal you are taking (150 mg) is a good solid dose.  You might not need that much, especially since you are doing better.  It is common to need less of a medicine to sustain improvements after an acute episode of difficulty.  The decrease should occur slowly.  Skin takes a while to heal and adjust to medication changes.  I would recommend decreasing to 100 mg for a few months and then, if needed, more cautious tapering (eg by 25 mg every month or two).  You are really balancing how you feel with improvements in your skin condition.  One way of enhancing your mood as you lower the Lamictal is to maximize the Lexapro you are taking.  For example, you may only need 100 mg of Lamictal when you are on 20 of Lexapro and your skin might be better.   If, as you decrease the Lamictal dose, your acne remains bad and your mood begins to become more depressed . . . you have a difficult choice to make. 

3.  Other options–The fact that the addition of a mood stabilizer to an antidepressant has helped your mood opens the door to other mood stabilizer options, namely Abilify.  Recent work (and my clinical experience) shows that the addition of Abilify to an antidepressant can be helpful in improving mood.  Abilify comes with its own side effect difficulties, but at least it does no cause acne.

Remember, no medication changes should take place without a consultation with your psychiatrist. Make sure that you tell your doc about any over-the-counter agents you are taking as well as any herbal supplements.   I’m also glad to hear that you are seeing a dermatologist.  There are many new products for acne and choosing which one will help can be quite difficult.  Also, you should have hormonal studies done to make sure that there are not underlying reasons for your hair and skin difficulties.  As you so eloquently summed it up in your last sentence . . . mental health issues are a big pain in the butt!!! Make sure you are working actively with a psychiatrist and make your changes in a slow and methodical fashion.  It increases the chance that you will ultimately find the combination of medicines that work effectively for you.

–Dan Hartman, MD

17 comments to Lamictal and acne

  • Dan

    Great tips, thanks! By the way, I don’t recommend anyone using ProActiv for treating acne… I just tried it last month, and it really irritated and dried out my skin.

  • Vicki

    Really good advice. I feel the same as the woman. Mental issues are a pain in the butt. I’ve had severe depression problems my entire life and have recently found the courage to get help. I was also put on Lamictal and Lexapro about 7 or 8 weeks ago. I’ve had a range of side effects. The psych. wanted me to go up to 100mg/day of Lamictal, but am afraid to do it given the current side effects, and that I have Thalassemia (spelling?). I’ve kept myself on 50mg/day and haven’t yet discussed it with the doc because I haven’t yet gone back since she said to increase it after the 5th week.

    Side effects: lumps in my throat, cyst-like lumps that I’m concerned about (could be lymph node enlargement from the drug, could be from Hashimoto hypothyroidism…not sure) I’ve never felt these fairly large sized lumps before, so it’s a concern; some acne problems on the lower jaw; blurred vision (on occasion); fever and flu like symptoms for a week (never get sick, so could have just been me getting sick, but a weird coincidence); dry mouth; difficulty swallowing; weight gain (could not be related, but it’s irritating non the least); sleepy; waking up in middle of the night with difficulty returning to sleep.

    Is it worth it? I’m struggling with this because I do feel so much better, but I still have zero energy and am really concerned about having a blood disorder taking this drug and just worried about a lot of the side effects I’ve been having.

    Any advice? I will speak with my psych. and I also have an appointment with my primary care doc to discuss all, but any additional advice from any experts would be appreciated. Thanks.

  • Vicki–Wierd bunch of side effects. Problem with starting two meds at once is that you never know which caused problems if they do arise. There should be no difficulties with Lamictal and the Thalassemia. The presence os what seems like a low grade infectious process is concerning. Not likely due to the meds but you never know. I hope that you went to your family doc. If not . . . get there. If the doc does not find any other cause for your medical issues, I would suggest stopping the Lamictal first. It can be a messy med for some people . . . much less likely with the Lexapro.

    –DH MD

  • hi,

    I was on Lamictal for a long time….i stopped takin it about 4 motnhs ago when i realized i didn’t need it. I am also Bi-Polar and have depression….my doctors decided to put me on Wellbutrin….which has helped me morre then anything….hope this helps some


  • nat

    I suffer from bipolar disorder and I was put on lamictal 100mg and geodon 20mg. It seemed to work great for my mood. However, my face has suffered because of the lamictal. The acne along my jawline and cheeks is gross. I went to see my psychiatrist and he suggested that I get off it and go on topamax. Lamictal works well, but the acne it causes made me feel bad. I tried proactive and other expensive acne products but the acne kept coming. I’m also going back on Yaz because that helped with my mood too and it helps with acne.

  • Nat– Sorry to hear about the acne. As you can read, it is a big problem for many people. Lowering the dose may help, especially with the addition of the Yaz if that was previously helpful. I am not a big Topamax fan, only because in my limited use of it, I have not had great success (but no crash and burn failures, either). Sounds like you have a doc who is listening and willing to try options . . . keep trying your options . . . there is likely a solution for your mood issues that will not require such a difficult trade off.

    –DH MD

  • Mary

    I hate to say it, but I was relieved to hear that many others reported gettting acne (especially along jawline) from Lamictal. I complained about this to my Psyciatrist, but he said he never heard of that being a side effect. I, also was feeling so blah, lost my self-esteem and confidence to do my job (and quit) and could not get any endorphin release from aerobic exercise, listening to music & playing my trombone. I became so very depressed and stopped doing these activities which have been trustworthy coping strategies (am 47 yrs old). I told this to my Dr. and he insisted that I was not depressed which made me more depressed to have a Dr. who I thought understood me discount my feelings. Anyways, I have gone back to my former psychiatrist (reluctantly b/c have to pay out of pocket) b/c he has known me for almost 3 years and validated that I am depressed. I got off the 200 mg Lamictal within 1.5 weeks which gave me terrible anxiety. I tried Prozac which made it worse and went off of that. Now I have been on 50 mg of zoloft for 2 weeks & still feel depressed. I saw my Dr. today & he told me to bump the dose up to 100 mg and then to add Topomax. I fear adding a second drug especially a mood stabilizer since I had such bad experience with the Lamictal. I just want to be on one drug for now and only to be on an antidepressant for now b/c I have not been in a hypomaniac mood since January. Do you think going off the Lamictal too quickly caused me to go deeper into depression? Do you think I should wait and see if the Zoloft pulls my mood up? I am currently not working b/c of all I mentioned above and can barely take care of myself and my 5 yr. old daughter. People who know me would not recognize me b/c I have always been upbeat, positive and motivated. Now I can barely get up and take my daughter to preschool and then in another week get her off to K-grade. Oh, and yes, I have been getting talk therapy on a weekly basis for the past 4 years. Please advise…..I am in the process of trying to find a Dr. in my insurance network to get another oppinion. Thank you for your assistance….I am desperate!

  • Dee

    acne on chest every time i go back on lamictal. of course it is related.

  • Sandro . . .

    Thanks, dude . . .

    . . . DH MD

  • BipolarBear

    Lamictal caused terrible acne for me. It is a bummer to be 40 years old and have a face like a pimply 17 year old…looking young is usually nice, but not in that way.

    Anyway, I saw a dermatologist and got a prescription for Clindamycin Phosphate lotion in the morning, and Tretinoin cream at night. The combo has worked wonders (although it took several weeks to take effect), and my face is completely clear now. Tretinoin is also used to treat wrinkles, so I’ve had the added benefit that my face is looking more youthful too (in the good way).

    My face is still excessively oily though, so I have to re-powder it often during the day.

  • Traci

    I find the comment about would you rather feel good or look good extremely condescending. This assumes that you cannot have both. Actually for me, if I feel like I’m the ugliest person alive I don’t care how great the medication is, I’m going to be depressed. I have only been on the Lamictal for two weeks and have canceled client appointments and nights out with friends because I cannot stand the way I look with all this acne. I’m glad my doctor is not so condescending and willing to work with me until we find the right drug that no only makes me feel better but doesn’t have the nasty side effects to go with it.

  • Traci–

    What comment about rather feeling good or looking good??? I can’t find that comment in my comments or article? Seems to me the message is to find a doctor who will work with you and help you get through those tough decisions. With any of the medications that are used in medicine or psychiatry, it is a balance between the benefits and the side effects. If you can’t stand the side effects than you gotta look for a new solution. Problem is that for some people, there is just no way around the presence of some side effects (eg, acne, sexual side effects, weight gain). Part of the work done with the therapist/psychiatrist is getting comfortable enough with those side effects to live a good life. That is not condescending . . . sometimes it is the hard and difficult truth. That said, seeking a medication that works without side effects is ALWAYS the prime directive.

    –DH MD

  • Darlene

    I have been recently diagnosed w/bi-polar disorder, have been on many many different anti-depressents over the yrs, now my pych dr. wants me to try a mood stabilzer even though I suffer from acne & meds only make it worse. I don’t know what to do.

  • Darlene–

    HANDS DOWN!!! I would give it a try. I assume that the mood stabilizer you are referring to is Lamictal. Can Lamictal cause worsening of acne . . . yup. Can it provide for significant improvement in mood, overall improvement in feelings of well-being, happiness, contentment, relief from suicidal thoughts . . . yup.

    Do the math.

    You don’t know what side effects it will cause. You don’t know what the benefits will be. I suggest you do a benefit/risk analysis and decide for yourself. If it was up to me, I would choose the chance for happy over the risk of acne. If my acne got worse, I’d treat it or stop the Lamictal.

    What is relief from depression worth to you????

    You decide.

    –DH MD

  • Sandra

    I also told my psychiatrist and looked online – he hadn’t heard anything and I had trouble really finding anything clinical about the acne side effect.
    It was BAD acne, jeez. I had ALSO gone on YAZ at the same time for PMS and MILD acne…so I stopped the Lamictal cause I thought it was causing that and salt cravings (I got blood tests later which were another issue). I found out a couple weeks ago that the anti-androgen in yaz (the analog of Spiro) can cause Adrenal Fatigue like symptoms (or AF straight out), which it was starting to in me, but it cleared up when I went off of it. I think the Lamictal caused the acne and the YAZ caused the other stuff…maybe..JEEZ is it hard to know. The acne continued for several weeks after I went off of of Lamictal but skin is like that…

  • Elizabeth

    Dear Dr. Dan ~

    You are quite mistaken when you state that Abilify does not cause the exact same type of cystic acne around the jawline and throat as Lamictal ~ because it does!!! There are quite a few blogs out there filled with otherwise happy Abilify users complaining about their acne. Dermatologists do not seem to have a handle on this new drug driven form of acne at all, and a lot of people are really suffering. Do you have a non-acne causing alternative suggestion to Abilify?