Valproate-associated hair abnormalities: Pathophysiology and management strategies.

Abstract

To review the literature on valproate-associated hair abnormalities and the available treatment options. We searched PubMed and Google Scholar with keywords including "valproate", "valproic acid", "hair", "alopecia", and "effluvium," supplemented with hand search from cross-references. We included all types of studies including case reports in this review. The pathophysiology of hair loss includes telogen effluvium, biotin, mineral deficiency, and possibly hyperandrogenism. Diagnosis is based on history of hairloss or abnormalities following valproate treatment, and is confirmed by use of simple clinical tests such as pull test and modified wash test. Treatment involvesreassurance and advice on hair care, and if possible drug discontinuationordose reduction. Medications such as biotin and other vitamins with mineralssupplementation is effective for most individuals with hair loss. Other treatment options are agomelatine, topical valproate or minoxidil, though these lack evidence. Hair abnormalities with valproate are common, benign adverse effects, and management includes general measures and specific treatment options.