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Yellow nail pigmentation following Depakote therapy
Robert Buka1, Rachel Hille, Patricia McCormack
1Department of Dermatology, New York Medical College, Valhalla, New York, USA.
Journal of Drugs in Dermatology : JDD
|October 16, 2003
Summary
Depakote (divalproex sodium) use in a 57-year-old female was temporally associated with significant nail discoloration. Discontinuation of Depakote led to nail plate normalization, suggesting a causal link.
Area of Science:
- Dermatology
- Pharmacology
Background:
- Dermatologic adverse reactions to anticonvulsants are documented.
- Nail pigmentation has been reported with other anticonvulsants like phenytoin and lithium.
Observation:
- A 57-year-old female developed transverse yellow bands and subsequent complete nail discoloration on all 20 proximal nails.
- These nail changes emerged two months after initiating Depakote (divalproex sodium).
Findings:
- Nail discoloration resolved six to eight weeks after Depakote discontinuation.
- The patient's history of renal disease with azotemia was deemed unlikely to be the cause.
- A strong temporal relationship between Depakote use and nail discoloration was observed.
Implications:
- This case suggests Depakote may cause nail discoloration, a reaction not previously reported.
- Clinicians should consider Depakote as a potential cause of drug-induced nail changes.
- Further investigation into the mechanism of Depakote-induced nail pigmentation is warranted.