Darier Disease with Acrokeratosis Verruciformis of Hopf and their Aggravation on Lithium Therapy for Bipolar Disorder

Darier disease (DD) and acrokeratosis verruciformis of Hopf are rare autosomal dominant skin disorders. Both are caused by a single gene mutation, i.e., ATP2A2 located on chromosome 12, which is expressed in the skin and brain. However, both the diseases are clinically and histopathologically distinct. DD is associated with many neuropsychiatric conditions such as depression, bipolar disorder (BPD), and seizures. Lithium is commonly used as a mood stabilizer in psychiatry and is reported to aggravate DD. We report a case of a 17-year-old female with DD and acrokeratosis verruciformis with associated with BPD Type 1 presenting with an aggravation of skin lesions after starting lithium therapy.