Exfoliative Dermatitis (Sodium Valproate Induced)

Abstract

G Nabi, Exfoliative Dermatitis (Sodium Valproate Induced). 1993; 13(4): 388-389To the Editor: Exfoliative dermatitis is an erythematous scaling eruption which involves most or all of the skin. The eruption can vary from slight scaling and minimal redness to generalized desquamation associated with systemic toxic symptoms [1]. Sodium valproate is being used for febrile convulsions with no particular toxic effect in young children [2]. We are reporting a case of recurrent febrile convulsions who was put on long term anticonvulsive therapy, sodium valproate, and developed one of the rare complications, exfoliative dermatitis, with this drug.A two-year-old Sudanese male presented with a history of recurrent convulsions since the age of nine months. He had five attacks of convulsions until he reported to our clinic. Each attack lasted from three to five minutes, tonic clonic type, always associated with respiratory tract infection and fever. The patient was getting the treatment for each episode from the local dispensary, syrup ampicillin and paracetamol. Antenatal, natal, and postnatal history were uneventful. There was no family history of convulsions or skin disease. On examination, the patient was of average build and undernourished; growth parameters were a weight of 10 kg (below the tenth percentile), length 85 cm and head circumference 48 cm, both normal. Vital signs were within normal limits. There was no neurological deficit and all other systems were clinically normal. Investigations: hemoglobin, total leucocyte count, total proteins, serum electrolytes, blood glucose, blood gases, x-ray of the skull, electroencephalography, and liver function tests were all normal. The patient was put on long term anticonvulsive therapy of Depakine syrup (sodium valproate) 20 mg/kg/day in two divided doses per oral for a period of two years.Six weeks after starting the treatment, he developed generalized redness of the skin with itching all over the body. The erythema was a bright red, classical allergic drug rash. The patient was taking only Depakine and no other medication. There was no fever, jaundice, lymphadenopathy, hepatosplenomegaly, or signs of congestive cardiac failure. The drug was stopped and the patient was put on chlorpheniramine maleate syrup 0.35 mg/kg/day in three divided doses per oral. Local application of calamine lotion was used as a soothing agent. Itching subsided and desquamation started; this lasted for a period of two weeks. In a total period of one month, skin was normal and the child was healthy. He is coming for follow-up regularly.Sodium valproate is a widely used drug for febrile convulsions. Usually in therapeutic doses, there are minimal side effects [2]. One of the rare complications of this drug is hepatotoxicity (one per 10,000 patients) [3]. Idiosyncrasy has been reported in some cases but exfoliative dermatitis due to this drug is very rare [4]. Exfoliative dermatitis is more common in adults than in children and males are affected more than females [5]. The patient developed skin ras...