New, October 2008
CHICKENPOX & LITHIUM
Varicella-Zoster virus infection
The Varicella-Zoster virus is a member of the herpesvirus group. Since Lithium has been reported to have a prophylaxis effect for the related Herpes simplex viral infections, there seemed a likelihood that it may have some beneficial effects for Chickenpox. This report is an unstructured, subjective assessment of the use of Lithium for Chickenpox as applied clinically over more than 10 years.
Whilst there is now immunization available to prevent endemic infections, there is a financial cost that some may not be prepared to carry and, in less prosperous countries (where there is probably little immunization) this report may be of some benefit.
With a few exceptions, most patients were children or teenagers seen in primary care. In order to be considered eligible for the treatment the following criteria were applied :
Lithium Dosage and Administration: The dose of Lithium carbonate (as 250 mg tablets) was based upon a rough assessment of patients’ bulk. Thus, as examples, a non-obese adult male received 1 g (4 tablets; refer to Figure 1), and a slim, short, prepubertal 12 year old female received 500 mg (2 tablets). The tablets were administered together as a single bolus with liquid, preferably after some food.
Complications: The only complication noted was nausea &/or emesis, particularly if the tablets were taken on an empty stomach (which was specifically avoided).
Results: The impression was that the Lithium treatment seemed to abort further progression of the condition: blisters that had formed already would burst and go on to from crusts, but the macular-papular early skin lesions did not seem to progress to blisters, or if they did, they were not appreciable (refer to Figure 1).
Figure 1. A 31 year old non-obese male reported having a 2-3 day rash on the 16th of May, He received 4x250 mg Lithium carbonate tablets (= 1 g) as a single bolus, reporting later that he dry retched about 90 minutes afterwards. (This dose was probably rather higher than usual.) The photograph was taken on the 19th of May. Blisters seen initially have now burst, leaving shallow ulcers (some are black arrowed) highlighted by the off-white anti-pruritic lotion he had been applying. The other surrounding macules and papules have not progressed appreciably into blisters, but have changed colour to dusky pink (red arrows), indicative of a declining inflammatory response (ie resolution).
Discussion: The experience described here suggests that Lithium, if administered early in the course of a Chickenpox skin rash may abort the further progression of the condition. Because of the nature of the infection (sporadic, involving children and not usually having major complications) it is usually seen in suburbia by doctors of first contact. Accordingly, any more rigorous assessment of the value of the lithium treatment will be difficult to plan and conduct.
The treatment is so safe, cheap and easy that doctors could carry a small number of Lithium carbonate tablets in their doctors’ bags, so that treatment may be administered promptly, without the need for a specific prescription.
A small percentage of patients with Chickenpox develop severe complications, such as lesions in the central nervous system (in particular), and some patients with leukaemia or lymphoma may develop “progressive varicella,” with visceral involvement. At this stage, one may only hope that Lithium treatment may lessen the risk of these complications developing, given that there has been a small mortality from this disease, which still may be common in some parts of the world.
Malcolm Adams Traill
Copyright© October 2008