Skin and Brain in Bipolar Disorder

Dermatologic and psychotropic therapies intersect frequently in patients with bipolar disorder, in whom systemic dermatologic medications may affect mood stability and mood stabilizers or antipsychotics may produce clinically important cutaneous adverse reactions. Because several medications discussed in this review are also used for psychotic disorders, severe or treatment-resistant major depressive disorder, suicidality, and other psychiatric conditions, this article distinguishes medication-related risks from considerations specific to bipolar disorder. This narrative review synthesized English-language literature indexed in PubMed through June 29, 2026 addressing psychiatric adverse effects of dermatologic therapies and dermatologic adverse effects of psychotropic medications relevant to bipolar disorder. The literature consisted largely of case reports, case series, observational studies, pharmacovigilance analyses, and narrative or systematic reviews. No randomized controlled trials directly evaluating these bidirectional interactions in bipolar disorder were identified. Dermatologic agents such as isotretinoin, systemic corticosteroids, and methotrexate have been associated with mood destabilization in susceptible patients. Conversely, lithium and lamotrigine carry important dermatologic risks, including acneiform or psoriasiform eruptions, hidradenitis suppurativa, and severe cutaneous adverse reactions. Dermatologic-psychiatric drug interactions can be clinically significant and require careful screening, counseling, and longitudinal monitoring. Dermatologists, psychiatrists, and primary care clinicians should collaborate when initiating or modifying high-risk therapies, especially when psychiatric history, prior cutaneous drug reactions, polypharmacy, or rapid dose escalation increase risk. .