Sodium Valproate-Induced Hyperpigmentation

An 11-year-old boy developed hyperpigmentation on his face and neck after starting sodium valproate for epilepsy, with symptoms appearing 4 weeks after initiation and worsening over 9 months. The pigmentation was slate-gray and not accompanied by other skin issues or systemic symptoms. Laboratory tests were normal, leading to a diagnosis of valproate-induced hyperpigmentation. After discontinuing valproate and switching to levetiracetam, the pigmentation began to fade within 3 months. While drug-induced hyperpigmentation is common, cases involving sodium valproate are extremely rare, with only one other reported instance. Clinicians should be aware of this potential side effect to manage it effectively.