정신과 약물에 의한 피부 부작용

초록

Cutaneous adverse drug reactions are well-documented with psychiatric medications, particularly mood stabilizers, antidepressants, and antipsychotics. Although their overall incidence is relatively low, these reactions can significantly affect treatment adherence and, in rare instances, lead to life-threatening conditions such as Stevens–Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS). Most psychiatric drug-induced skin reactions are unpredictable and idiosyncratic, typically not dose-dependent. Identified risk factors include female sex, older age, genetic predispositions such as specific human leukocyte antigen (HLA) subtypes, high initial dosing, rapid dose escalation, and the presence of certain comorbidities. Mood stabilizers, particularly lamotrigine and carbamazepine, are most frequently implicated, but antidepressants and antipsychotics are also associated with a broad spectrum of cutaneous manifestations, including pruritus, exanthematous eruptions, urticaria, photosensitivity, pigmentary changes, alopecia, hyperhidrosis, and immune-mediated syndromes. Diagnosis requires careful assessment of the temporal relationship between drug initiation and symptom onset. While most reactions are self-limited and resolve with dose reduction or discontinuation of the offending agent, severe cases require immediate cessation and prompt dermatologic consultation. Management is largely supportive and symptomatic, with systemic or topical therapies used as needed. Clinicians should remain vigilant regarding potential cutaneous side effects of psychiatric medications and implement individualized treatment strategies to minimize harm. Advances in personalized medicine and pharmacogenetics may facilitate better prediction and prevention of these adverse effects.

키워드