Nail Hyperpigmentation Following Valproic Acid Use: A Rare Case Report

A 22-year-old male, treated with valproic acid (1gm/day) for acute manic symptoms, developed brownish-yellow discoloration of all fingernails and toenails after 2 months of use. The patient had no other systemic diseases, negative tests for infections, and no other drug use. Discontinuation of valproic acid led to the resolution of the hyperpigmentation. This case highlights that valproic acid can rarely cause nail and nail bed discoloration, likely due to drug metabolite deposition or iron deposition from blood vessel damage. Awareness of this potential side effect is important for prompt management and can be reversible with early identification and cessation of the drug.