A case of superficial pemphigus induced by sodium valproate

Abstract

Iatrogenic pemphigus is a rare entity in routine dermatological practice, particularly in its superficial clinical form. We present a case of superficial pemphigus induced by sodium valproate. Our patient, a 70-year-old female, was being managed for epilepsy with sodium valproate. The interval between the initiation of treatment and the onset of symptoms was approximately one year. Clinical examination revealed oozing erythroderma with blisters and post-bullous erosions predominantly localized to seborrheic areas, along with a positive Nikolsky sign. Histological examination, complemented by direct immunofluorescence, confirmed the diagnosis of superficial pemphigus. Based on clinical findings, histological results, and a review of the literature, the diagnosis of sodium valproate-induced superficial pemphigus was established. The patient achieved remission following the discontinuation of sodium valproate and the initiation of systemic corticosteroid therapy. While cases of drug-induced pemphigus have been documented, this is, to our knowledge, the first report implicating sodium valproate in our department. Identifying the causative drug in drug-induced pemphigus can be challenging, particularly in polymedicated patients, as the latency period between drug initiation and symptom onset can vary widely. Drug-induced pemphigus should be considered in any patient presenting with pemphigus, especially in elderly individuals undergoing multiple treatments. In most cases, withdrawal of the offending drug combined with systemic corticosteroid therapy results in clinical improvement.