Case report
Finger-nail onycholysis, leukonychia and acrocyanosis in a patient treated with valproic acid – case report

We present a case of a 30-year old female patient presenting with acrocyanosis and nail changes (leukonychia, onycholysis), who has been treated with valproic acid for 3 years. Acrocyanosis, listed in the group of acrosyndromes, is a painless condition, characterized by symmetrical discoloration of various shades of blue colour, localized within the hands, feet and face, often associated with hyperhidrosis of hands and feet and exacerbated by cold. Due to possible multifactorial aetiology of symptoms, this case may be considered as a diagnostic challenge. Valproic acid has been described as a causative factor of various skin and nail conditions, including onycholysis. On the other hand, nail abnormalities have been observed in patients with acrosyndromes (for example erythromelalgia). Capillaroscopy and photoplethysmography revealed numerous abnormalities. The patient needs further observation and monitoring of any possible signs and symptoms of connective tissue diseases.