Curly Hair Induced by Valproate in Bipolar Disorder.

TO THE EDITOR

Hair loss or hair color change in patients taking valproate has been repeatedly reported.1–3) However, drug-induced hair texture changes have been reported rarely.4) Curly hair is a very rare side effect of valproate.5) Valproate is recommended for the acute treatment of mania and maintenance of bipolar disorder as a mood stabilizer.6) Valproate can be used also in the treatment of epilepsy. In a study of 250 patients, Jeavons et al.7) noticed five (2%) patients developed curliness of the hair due to valproate. Wilting et al.5) described a 47-year-old white female patient experiencing curling of the hair during treatment with valproic acid. There is no bipolar disorder patient whose hair curling with valproate, in the literature. I have noticed valproate induced curly hair in a patient with bipolar disorder. This is the only reported bipolar disorder case of a patient experiencing hair curling as a result of taking valproate. Written informed consent for publication was obtained from the patient.

The patient is 47 years old and has had a diagnosis of bipolar disorder for three years. She has experienced two manic episodes. She has been treated with valproate 1,000 mg/day for three years. At the sixth month of valproate usage, she noticed that her hair was getting curly. Her hair has remained curly. She has never had any perming of the hair performed. She doesn’t describe any other hair-texture change. She prefers curly hair and doesn’t want to change to another mood stabilizer. There isn’t any other side effect of valproate in this patient. The patient reports that her treatment with valproate has gone well; however, she discontinued valproate in 2014 for a period of five months, resulting in a second manic episode. Her manic episode was managed by starting valproate again. Her hair remained curly whilst she refrained from taking valproate.

The mechanism of valproate induced effects on hair is unclear; however, it may be related to the effects of chelating of metals (copper, zinc, and magnesium) as well as inhibition of metallic enzymes.5) Curling of the hair is an unusual side effect of valproate in bipolar disorder, so psychiatrists must inform patients about this side effect too.