[medicalfox]

Has anyone here (or know someone) that has gotten papules and a rash from lamictal? My face broke out in a rash and I got papules on my lips, but idk if it's from my med or not. I talked to my neurologist and he said I could be allergic to something that I ate, but also said anything could have caused this. Should I change my med? I use lamictal for epilepsy, mania, and depression so this medication or one similar is required for me to stay stable.

[Rapunzel]

If it is from the lamictal, it can be very serious and you need to tell the doctor who prescribed the lamictal and ask him or her what you should do. You shouldn't make changes without talking to the doctor, but you need to talk to the doctor about it.

Lamotrigine (Lamictal)

[medicalfox]

Originally Posted by Rapunzel

If it is from the lamictal, it can be very serious and you need to tell the doctor who prescribed the lamictal and ask him or her what you should do. You shouldn't make changes without talking to the doctor, but you need to talk to the doctor about it.

Lamotrigine (Lamictal)

Thank you for this link! It's a really great site.

I see two physicians (my psychiatrist and neurologist) about my lamictal, who do I talk to first? The psychiatrist prescribed it first for mania, but I recently got diagnosed with temporal lobe epilepsy which is why I see the neurologist.

[Rapunzel]

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

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

1. Stop for any rash anywhere.
2. Have a dermatologist see the patient within 24-48 hours; hold the doses until seen.
3. 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.

[medicalfox]

My neurologist told me to see my pcp then she could refer me to a dermatologist if I was concerned about my rash. I see my pcp today if the snow storm doesn't close everything down.

[Rapunzel]

Let us know how it goes. Stay safe in the snow storm! Sounds like another bad one. We are thawing where I live, and it is sunny, but muddy.

[medicalfox]

I couldn't get a hold of the nurses because the facility closed due to the bad weather. I'm going to try again later in the day and hope the streets are cleared.

[medicalfox]

Update- I talked to the nurse and she said that it most likely wasn't the lamictal that gave me those reactions and that the exotic fruit juices I have been drinking gave it to me. I am staying on the lamictal for now