Annals o Medicine Resea ch and Public Heal h
Case Repo (ISSN: 2995-5955)
Ann Med Res Pub Heal h (AMRPH) 2025 | Volume 4 | Issue 1
Lamo igine-Induced Rash and Facial Swelling in a 27-Yea -Old Female: A Case
Repo
Ha leen1, Saloni1*, Se h AK1, Na ej Singh2
1Depa men o Psychia y, San osh Medical College and Hospi al, Ghaziabad, 201001, India
2Depa men o Skin, M.H. Jalandha , 144005, India
Ci a ion: Ha leen, Saloni, Se h AK, Na ej Singh. Lamo igine-Induced Rash and Facial Swelling in a 27-Yea -
Old Female: A Case Repo . Ann Med Res Pub Heal h. 2025;4(1):1-5.
Recei ed Da e: 04 No embe , 2025; Accep ed Da e: 06 No embe , 2025; Published Da e: 08 No embe ,
2025
*Co esponding au ho : Saloni, Depa men o Psychia y, San osh Medical College and Hospi al, Ghaziabad,
201001, India
Copy igh : © Saloni, Open Access 2025. This a icle, published in Ann Med Res Pub Heal h (AMRPH)
(A ibu ion 4.0 In e na ional),as desc ibed by h p://c ea i ecommons.o g/licenses/by/4.0/.
ABSTRACT
Lamo igine, a widely used an iepilep ic and mood s abilize , is associa ed wi h a isk o de ma ologic
hype sensi i i y eac ions, which can ange om mild ashes o se e e cu aneous ad e se eac ions. We epo
he case o a 27-yea -old emale wi h ecu en dep essi e diso de who de eloped widesp ead ash and acial
swelling ollowing ini ia ion o Lamonex SR (lamo igine) 100 mg once daily wi hou i a ion. P omp
ecogni ion and discon inua ion o he d ug led o comple e esolu ion o symp oms. This case highligh s he
impo ance o ca e ul i a ion and ea ly moni o ing when ini ia ing lamo igine.
Keywo ds: Lamo igine, d ug hype sensi i i y, d ug-induced ash, acial edema, ad e se d ug eac ion,
ecu en dep essi e diso de
INTRODUCTION
Lamo igine is an an iepilep ic d ug commonly p esc ibed as a mood s abilize in bipola diso de and, less
equen ly, as an augmen ing agen in ea men - esis an dep ession.
While e ec i e, i ca ies a well-documen ed isk o de ma ologic hype sensi i i y eac ions, which occu in up
o 10% o pa ien s, mos equen ly wi hin he i s wo o eigh weeks o he apy [1,2]. These ashes ange om
benign e up ions o po en ially li e- h ea ening condi ions such as S e ens–Johnson Synd ome (SJS) and D ug
Reac ion wi h Eosinophilia and Sys emic Symp oms (DRESS).
The isk o ash is s ongly in luenced by dose and i a ion schedule. Since he in oduc ion o a g adual dose-
escala ion egimen in 1994, he incidence o se e e ashes has declined signi ican ly om app oxima ely 1% o
0.1–0.01% [3]. Howe e , benign ashes emain common, wi h a epo ed equency be ween 8–11% [4]. Facial
swelling is less equen ly desc ibed bu may ep esen an ea ly wa ning sign o sys emic hype sensi i i y.
Annals o Medicine Resea ch and Public Heal h
Case Repo (ISSN: 2995-5955)
Ann Med Res Pub Heal h (AMRPH) 2025 | Volume 4 | Issue 1
He e, we desc ibe a case o lamo igine-induced ash and acial edema in a young emale wi h ecu en
dep essi e diso de , occu ing wi hin he ea ly phase o ea men and associa ed wi h ini ia ion a a non- i a ed
dose.
CASE PRESENTATION
A 27-yea -old ma ied emale, mo he o wo child en, p esen ed wi h pe sis en low mood . The pa ien
desc ibed he mood as pe sis en ly low, wi h a sense o sadness and hea iness p esen h oughou he day. She
epo ed equen ea ulness, eelings o hopelessness and helplessness, and exp essed ha he emo ional s a e
emained unchanged e en when ci cums ances imp o ed. She also desc ibed inc eased i i abili y leading o
di icul y concen a ing on household asks. This was accompanied by excessi e wo y abou daily
esponsibili ies and he child en’s well-being, along wi h soma ic ension such as palpi a ions and muscle
igh ness. These symp oms o en wo sened a nigh , in e e ing wi h he abili y o all asleep., dis u bed sleep,
inne es lessness (“uljhan”), anhedonia. She desc ibed di icul y de i ing pleasu e om p e iously enjoyable
ac i i ies, a igue, and dec eased mo i a ion. She desc ibed he sel as emo ionally numb, s a ing ha e en
posi i e e en s ailed o li he mood. This led o social wi hd awal, eluc ance o pa icipa e in amily
ga he ings, and eelings o guil o no being able o engage wi h he amily., and pe asi e nega i e hough s.
She endo sed pe sis en nega i e hough s abou he sel and he abili ies. She desc ibed eeling like a bu den o
he amily, wi h educed sel -con idence and wo hlessness. She wo ied excessi ely abou he inabili y o
unc ion as a good mo he and wi e, despi e eassu ances om he amily. No suicidal hough s o in en we e
epo ed a he ime o assessmen . She desc ibed di icul y de i ing pleasu e om p e iously enjoyable
ac i i ies, a igue, and dec eased mo i a ion.
She had a known his o y o Recu en Dep essi e Diso de (unipola , ICD-10: F33), wi h wo p io dep essi e
episodes occu ing app oxima ely h ee and wo yea s ea lie , bo h o which esponded o pha macological
ea men .
A p esen a ion, she was ecei ing luoxe ine 40 mg once daily, des enla axine 50 mg a bed ime, and
clonazepam 0.5 mg wice daily. Conside ing he ecu en cou se and pa ial esponse o an idep essan he apy,
lamo igine (Lamonex SR) 100 mg once a bed ime was ini ia ed as an augmen ing agen .
She had no pas o amily his o y o mania, hypomania, psychosis, subs ance use, o como bid medical illness.
Family his o y was non-con ibu o y.
On he 10 h day o lamo igine he apy, she de eloped acial lushing, pu iness, and widesp ead e y hema ous,
non-blanchable, maculopapula ashes in ol ing bila e al uppe limbs, unk and back The lesions we e p u i ic
in na u e. The e was no mucosal in ol emen , lymphadenopa hy, sys emic symp oms, o ea u es o
anaphylaxis.
Men al s a us examina ion e ealed a coope a i e and app op ia ely d essed pa ien , wi h low and anxious mood
and es ic ed a ec . Though con en was cha ac e ized by nega i e cogni ions wi hou delusions o
hallucina ions. Speech was no mal in a e and one. Cogni i e unc ions we e in ac , wi h p ese ed o ien a ion
and memo y. Insigh and judgmen we e in ac .
Annals o Medicine Resea ch and Public Heal h
Case Repo (ISSN: 2995-5955)
Ann Med Res Pub Heal h (AMRPH) 2025 | Volume 4 | Issue 1
Examina ion: Non-blanchable e y hema ous maculopapula ash on bila e al ex emi ies unk and back; mild
acial pu iness; no ai way comp omise o angioedema. Sys emic examina ion was no mal.
In es iga ions: Comple e blood coun , li e , and enal unc ion es s we e wi hin no mal limi s. No eosinophilia
was de ec ed.
Managemen and Ou come: Lamo igine was immedia ely discon inued. She was managed wi h o al
le oce i izine 5 mg once daily, opical emollien s, and cold comp esses. The pa ien was closely moni o ed o
sys emic ea u es o mucosal in ol emen . O e he nex 5–7 days, he ash and acial swelling g adually
esol ed, wi h no p og ession o se e e cu aneous ad e se eac ion.
Annals o Medicine Resea ch and Public Heal h
Case Repo (ISSN: 2995-5955)
Ann Med Res Pub Heal h (AMRPH) 2025 | Volume 4 | Issue 1
Figu e 1: Non-blanchable e y hema ous maculopapula ash p esen on le and igh sides o he
unk.
Figu e 2. P esence o non-blanchable e y hema ous maculopapula ash on he do sal and en al sides o he
igh hand.
DISCUSSION
This case illus a es a lamo igine-induced hype sensi i i y eac ion p esen ing wi h ash and acial swelling
wi hin he i s wo weeks o he apy. The iming and clinical ea u es a e consis en wi h p e iously epo ed
cu aneous ad e se e ec s o lamo igine [1,2].
Impo an ly, he pa ien was s a ed di ec ly on 100 mg once daily wi hou i a ion, which likely p ecipi a ed he
eac ion. Cu en guidelines emphasize a slow dose-escala ion schedule (s a ing a 25 mg once daily, inc easing
e e y 1–2 weeks) o minimize ash isk [3,4]. Concomi an use o alp oic acid u he inc eases isk, hough his
was no p esen in ou case [2].
Annals o Medicine Resea ch and Public Heal h
Case Repo (ISSN: 2995-5955)
Ann Med Res Pub Heal h (AMRPH) 2025 | Volume 4 | Issue 1
While he eac ion in his pa ien emained limi ed o he skin and so issues, he p esence o acial swelling is
clinically signi ican , as i may he ald p og ession o mo e se e e sys emic hype sensi i i y. P omp ecogni ion,
discon inua ion o lamo igine, and suppo i e managemen a e essen ial o p e en complica ions.
This case unde sco es he impo ance o s ic adhe ence o ecommended i a ion schedules and close
moni o ing du ing he ini ial weeks o he apy, pa icula ly in psychia ic popula ions whe e lamo igine is
inc easingly used o -label as an augmen ing agen .
CONCLUSION
Lamo igine can cause hype sensi i i y eac ions anging om mild ashes o se e e cu aneous ad e se
eac ions. In his case, apid ini ia ion a a non- i a ed dose led o he de elopmen o ash and acial swelling
wi hin 10 days. Ea ly iden i ica ion and immedia e discon inua ion o lamo igine esul ed in comple e eco e y.
This case highligh s he c i ical impo ance o dose i a ion, pa ien educa ion, and igilance du ing he ea ly
ea men pe iod.
Pa ien Consen
Ve bal in o med consen was ob ained om he pa ien o publica ion o his case and associa ed clinical
de ails.
REFERENCES
1. Gube man A, Co man C. An iepilep ic d ugs and ash: equency and isk ac o s.
Neu ology. 2000;55(4):589–594.
2. Hi sch LJ, e al. Risk o ash associa ed wi h alp oa e–lamo igine combina ion he apy. Neu ology.
2000;55(10):1438–1442.
3. GlaxoSmi hKline. Lamo igine P esc ibing In o ma ion.
4. A i H, Buchsbaum R, Wein aub D, Pie o J, Reso SR J , Hi sch LJ. Compa ison and p edic o s o
ash associa ed wi h 15 an iepilep ic d ugs. Neu ology. 2007;68(20):1701–1709.
