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Rapunzel · Feb 13, 2014, 03:48 AM

Which ever one can see you first. Another site that I found said to see a dermatologist within 48 hours if possible. Handling the lamotrigine rash

Quote:

If rash, then what?
There are ways to identify the rashes that carry great risk (e.g. Stevens-Johnson syndrome, SJS; and toxic epidermal necrolysis, TEN. Sounds scary just naming it. But that's all right, because this is indeed a very scary skin condition). The problem is that simple rashes, lacking the known danger signs, can also be risky, so it's not easy to say "oh, this rash is safe". And since there is a very low rate of severe skin reactions that can (rarely) even be fatal, any rash that appears while a person is taking lamotrigine should raise concern.
What are the signs of great risk? Here are the versions I've heard so far:

"Anything above the neck"
"Around or in the mouth"
"Soft tissues (like mucous membranes of mouth, nose, eyes -- including the membrane over the eye (conjunctiva), so a red, sore eye counts) (or the ****, also a mucous membrane, also counts)
"Anything on the face"

Obviously these all describe nearly the same areas, but the "soft tissues" version is the most specific.
Three strategies for rash

Stop for any rash anywhere.
Have a dermatologist see the patient within 24-48 hours; hold the doses until seen.
Stop for any rash above the neck; for anything else, reduce the dose to the previous level, and hold it there until you can tell whether the rash is going away (if so, continue upward again but more slowly and/or by smaller steps; use Benadryl or topical Caladryl to control itching while you're waiting).

Why the hurry to see the dermatologist? Well, the obvious reason is because if there is a risk, you want to stop right away. Secondly, if the medication is stopped for more than 3 days (for any reason; some sources say four days, a few say 5), the patient must start again from the very beginning of the dose steps. Therefore if the patient can be evaluated very quickly, she can stop the medication, get a "green light" from the dermatologist, and resume the medication at the same dose.
If you don't have a dermatologist handy, then strategy #2 may not be practical. That leaves #1 and #3. Number 3 has been recommended in several meetings I've attended, e.g. by Dr. Lauren Marangell at the Menninger Utah meeting, Winter 2002. She spoke confidently of that approach there. There is at least one article which notes having used this approach successfully.e.g.Huang But at a more recent meeting, the manufacturer's representatives were more cautious: by their account, if you can't do #2, you should do #1.