Buka Robert, Hille Rachel, McCormack Patricia
Department of Dermatology, New York Medical College, Valhalla, New York, USA.
J Drugs Dermatol. 2003 Oct;2(5):545-7.
Two months after being started on Depakote (divalproex sodium: Abbott Laboratories Inc., Abbott Park, Illinois), a 57-year-old female noticed the development of a transverse yellow band on all 20 proximal nails that eventually led to complete nail plate discoloration. Six to eight weeks after discontinuation of Depakote, normalization of her proximal nail plates was noted. Other anticonvulsants such as phenytoin and lithium have been documented to lead to nail pigmentation. Although several dermatologic reactions to Depakote have been described, we are not aware of any reported cases of nail discoloration secondary to Depakote. While our patient did have a history of renal disease with azotemia, we find it highly unlikely to be a contributing factor secondary to the fact that our patient's abnormality did not present similar to the nail abnormalities of renal disease. In conclusion, we found the temporal relationship between Depakote initiation/discontinuation and the nail discoloration to be highly indicative of Depakote as the source. Other anticonvulsants such as phenytoin and lithium have been documented to lead to nail pigmentation. Although several dermatologic reactions to Depakote have been described, we are not aware of any reported cases of nail discoloration secondary to Depakote. While our patient did have a history of renal disease with azotemia, we find it highly unlikely to be a contributing factor secondary to the fact that our patient's abnormality did not present similar to the nail abnormalities of renal disease. In conclusion, we found the temporal relationship between Depakote initiation/discontinuation and the nail discoloration to be highly indicative of Depakote as the source.
在开始服用德巴金（丙戊酸镁钠：雅培实验室公司，伊利诺伊州雅培公园）两个月后，一名57岁女性注意到其20个近端指甲上出现了一条横向的黄色带，最终导致整个指甲板变色。停用德巴金6至8周后，其近端指甲板恢复正常。据记载，其他抗惊厥药如苯妥英和锂会导致指甲色素沉着。虽然已经描述了几种对德巴金的皮肤反应，但我们尚未知晓有任何因德巴金导致指甲变色的报道病例。虽然我们的患者有氮质血症肾病病史，但我们认为这极不可能是一个促成因素，因为我们患者的异常表现与肾病引起的指甲异常不同。总之，我们发现开始/停用德巴金与指甲变色之间的时间关系强烈表明德巴金是病因。据记载，其他抗惊厥药如苯妥英和锂会导致指甲色素沉着。虽然已经描述了几种对德巴金的皮肤反应，但我们尚未知晓有任何因德巴金导致指甲变色的报道病例。虽然我们的患者有氮质血症肾病病史，但我们认为这极不可能是一个促成因素，因为我们患者的异常表现与肾病引起的指甲异常不同。总之，我们发现开始/停用德巴金与指甲变色之间的时间关系强烈表明德巴金是病因。
