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Year : 2000  |  Volume : 66  |  Issue : 2  |  Page : 103

Nail changes after carbamazepine

Correspondence Address:
Adarsh Chopra

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Source of Support: None, Conflict of Interest: None

PMID: 20877044

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Antiepileptics are known to produce different types of side effects including nail changes. A 20-year-old epileptic man had yellowish discolouration followed by dystrophy and onycholysis of his 15 nails after taking carbamazepine for 3 months which cleared within six months after discontinuation of the drug. This type of change has not been reported earlier with carbamazepine

Keywords: Nail changes, Carbamazepine

How to cite this article:
Chopra A, Kaur m, Kular J, Chopr. Nail changes after carbamazepine. Indian J Dermatol Venereol Leprol 2000;66:103

How to cite this URL:
Chopra A, Kaur m, Kular J, Chopr. Nail changes after carbamazepine. Indian J Dermatol Venereol Leprol [serial online] 2000 [cited 2020 Jul 14];66:103. Available from:

  Introduction Top

Nail changes following the systemic administra­tion of the drugs has been reported in literature. [1] The various nail changes reported are; colour changes, shed­ding of nails, onycholysis, Beau's lines and pain. Drugs causing nail changes are mainly chemotherapeutic agents, psoralens, phenothiazines, purgatives, lithium, oral contraceptives, p-blockers, heavy metals, antico­agulants, diuretics, oral retinoids and antiepileptics. [2] Out of the antiepileptics, diphenhydantoin was reported to cause aplasia/hypoplasia of the nail plate in foetus. [3] Nail hyperpigmentation has been reported after dilantin in­gestion. [4]

  Case Report Top

A 20-year-old man presented to us with the com­plaint of discolouration and dystrophy of 15 nails. Dur­ing the detailed history taking, it was revealed that the patient was on antiepileptic drugs since December 1997. He was put on dilantin, but after 3 months of intake he developed acneiform eruptions. Dilantin was replaced by carbamazepine at a dose of 100mg thrice daily in April 1998. In July 1998, he observed nail changes. Thor­ough systemic and dermatological examination and rou­tine investigations were carried out and revealed no ab­normality. Nail examination showed involvement of 15 out of 20 nails in the form of yellowish-white discolouration at the proximal nail plate and the lunulae. The nail changes progressed over a period of 2 months, causing discolouration of the whole nail plate and ony­cholysis which led to complete shedding of the nails. KOH examination as well as culture of nail tissue was negative for fungus. Antifungal treatment along with B­complex and vitamin -A was given but no improvement was observed within three months time. In August 1998, carbamazepine was stopped and the patient was pre­scribed sodium valproate. During the next six months of follow up, new normal nail formation was observed.

  Discussion Top

Various antiepileptics are reported to cause a number of nail changes. Our case had acneiform le­sions with dilantin and when he was put on carbamazepine, he developed nail changes in the form of discolouration, lunular dystrophy and onycholysis. With the stoppage of carbamazepine newly formed nails were normal. This type of nail discolouration and dystrophy with carbamazepine was not reported in earlier litera­ture.

  References Top

1.Damel CR III, Scher RK. Nail changes secondary to systemic drugs. J Am Acad Derm 1984; 10 : 250-258.  Back to cited text no. 1    
2.Fenton DA, Wilkinson JD. The nail in systemic diseases and drug in­duced changes. In : Disesase of The Nails and Their Management. Eds Baran R, Dawber RPR. Blackwell Scientific Publication, London 1984; 248­265.  Back to cited text no. 2    
3.Hanson JW, Smith DW. The foetal hydantoin syndrome. J Pediat 1975; 87: 285-290.  Back to cited text no. 3  [PUBMED]  
4.Johnson RB, Goldsmith IA. Dilantin digital defects. J Am Acad Demn 1981; 5 : 191.  Back to cited text no. 4    


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