No further doses of depot were given: when the depot would next have been due aripiprazole 5 mg was started. A fortnight later, as there were no adverse effects, the dose was increased to 10 mg with the plan to increase further to 15 mg if tolerated. After starting on aripiprazole 10 mg daily there was no immediate change in mental state, and no initial side effects (such as nausea or insomnia), and he slept much better. He had pre-existing neurological pain in his left arm for which he was not specifically taking any treatment, which had previously disturbed his sleep significantly. After 2 weeks on this dose it was increased to the therapeutic dose of 15 mg a day. One day later his wife

reported that ‘the skin fell Inhibitors,research,lifescience,medical off his legs’ when she removed his socks (he was Inhibitors,research,lifescience,medical unable to do this for himself

due to poor mobility), and described fluid exuding through the skin of his abdomen. There was no mucosal involvement. On presentation to his GP he was immediately referred to the local accident and emergency department, from where he was admitted to an acute surgical ward. He was seen by two dermatology teams and diagnosed with a lichenoid drug reaction, which was attributed to the newly initiated antipsychotic aripiprazole. He was found to Inhibitors,research,lifescience,medical have extensive skin peeling on his right hand with evidence of pus. In theatre he underwent several surgical procedures including debridement of the skin on several parts of his body including his hands and soles of his feet, and fluid collected under the epidermis was aspirated. He was treated with intravenous antibiotics and fluids, and discharged after 6 days. Discussion Aripiprazole is an atypical antipsychotic that was licensed in the UK in June 2004 in its Inhibitors,research,lifescience,medical oral Inhibitors,research,lifescience,medical formulations. It has been described as a third-generation antipsychotic due to its slightly different mode of action. Unlike other antipsychotics which antagonize dopamine D2 receptors in the mesolimbic area of the brain, aripiprazole is a partial agonist at D2 dopamine and 5HT1a R428 clinical trial serotonin receptors, and an antagonist

at 5HT2 serotonin receptors. It has been postulated that through this combination of actions it stabilizes the dopamine and serotonin system. However, despite this alternative mechanism of action a Cochrane review [Bhattacharjee and El-Sayeh, 2008] concluded that aripiprazole was as equally effective as other typical many and atypical antipsychotics. Until January 2012 a total of 110 skin disorders associated with the use of aripiprazole (oral or intramuscular) have been reported to the Medicines and Healthcare products Regulatory Agency (MHRA) via the voluntary Yellow Card Scheme [Commission on Human Medicines/Medicines and Healthcare products Regulatory Agency, 2012]. None of the cutaneous adverse reactions were fatal, the majority were either hyperhidrosis and cold sweats (n = 30) or rashes (n = 23).