Type of article: Case Report: Comorbidity of Darier's disease and bipolar affective disorder: a case report

BACKGROUND: Darier’s disease (DD) is a rare, autosomal dominant Genodermatosis that occurs due to mutations in the ATP2A2 gene on chromosome 12q23-24 that codes for sarco/endoplasmic reticulum calcium ATPase (SERCA), causing desmosomal breakdown and acantholysis and may have pleiotropic effects on the skin and brain. The co-occurrence of various neuro-psychiatric diseases with DD has been reported, including mood disorders, epilepsy, mental retardation, slowly progressive encephalopathy, and schizophrenia. Lithium is an effective therapy used in psychiatry as prophylaxis against recurrent mania and to treat acute schizoaffective, impulsive disorders. DD may flare after lithium therapy, an association that has rarely been reported. CASE DESCRIPTION: We report a 45-year-old man with bipolar affective type 1 disorder of 20 years duration and with skin lesions of 30years duration of yellow brown, hyperkeratotic papules in a seborrheic distribution and nail changes which flared after he was administered lithium therapy for bipolar disorder. Histopathologic examination showed acantholysis and dyskeratosis, which was consistent with Darier’s disease. His mother also had similar eruptions and psychiatric disease. DISCUSSION & CONCLUSION: It is important to diagnose DD as it may flare after lithium therapy and such patients need sodium valproate.