Question: HELP!!! I am.very concerned that my 22-year old daughter has a serious rash, possibly SteveJohnsons syndrome, from taking Lamactil?!?! Here are the facts: She had eczema as a child. In the past 5 years, she frequently gets rashes from cheap metal jewelry or belt buckles. Her doctor has prescribed a cream which helps when my daughter gets that rash (and she actually uses the cream). She was diagnosed in early April 2014 as possibly being Bi-polar (this was diagnosed 2years ago as ADHD and considerable anxiety, but when her schooling and social life went downhill the past 4-6 months, a local psychiatrist and a XXXXXXX DC psychologist both suggested she try Lamactil in case she is BP. She was started on 25 mg of Lamactil in early April, increased to 50mg in early May, athen increased to 100mg a couple weeks ago so she has been on Lamactil for 9-10 weeks. Yesterday, as my ex-wife was driving me home from a 3-day hospital stay in which I had TURP surgery with considerable bleeding, my ex told me our daughter has a 'bad rash.' She has used this same terminology pre-Lamactil, and it has always meant my daughter has one of her cheap jewelry rashes that finally goes away when my daughter actually uses the cream. But an hour ago, I remembered the "black Box" warning that came with her initial prescription of Lamactil in early April. What do we do??? Does my daughter go to a dermatologist tomorrow after her big test, or does she go right to the ER now or tomorrow. What would the rash look like? What other symptoms might she have? Some medical websites said stop the Lamactil immediately. Is that advisable? What side effects would she have from stopping today or tomorrow? Am I over-reacting? Please help. XXXXXXX

Dr. Rodrigues, Thank you so much for the prompt response and putting my mind at ease. My daughter provided additional info last night that I think reinforces your assessment. She said she had a little bit of the rash 2-3 weeks ago, so that on the day she saw the Psychiatrist's physician assistant (PA) to increase her Lamactil from 50 to 100mg, my daughter showed the PA the rash. The PA said it was not from the medicine or at least not SJS or TEN (she said it would look very different). My daughter said the rash worsened in the last week or 10 days as she it has gotten warmer here and she has been sleeping on the floor in a sleeping bag (her bedroom not available temporarily). But she said when she put a clean sheet between her and the sleeping bag, at least she didnt feel the need to itch, so it appears the sleeping bag needs some washing. The rash itself is lots of very small reddish spots all over the back of both legs and near her stomach and arms, some are tiny scabbed spots from her itching. The PA, though not a dermatologist, also said whatever cream my daughter was prescribed by her PCP should be stronger.

If anything I have said alters your opinion, please let me know. I think we will follow your suggestion plan to get her to see a dermatologist early next week (since today is Friday already). THANK YOU SO MUCH!!! You have absolutely provided me with valuable information and direction (and reduced the my stress level significantly and, I'm guessing, her mother's).

The only follow-up questions I have are: (1) Generally, what would be the symptoms if someone did have rashes from SJS or TEN? (2) Should the dermatologist my daughter sees have a particular specialty or focus? Thank you again, XXXXXXX P.S. This has been a terrific service you have provided to me!