Skip to main content

Drug-induced hyperpigmentation

What is drug-induced skin? pigmentation?

Drug-induced skin pigmentation accounts for 10-20% of all cases of acquired infection. hyperpigmentation. Pigmentation can be induced by a wide variety of medications; the main ones implicated include non-steroidal anti-steroidsinflammatory drugs (NSAID), phenytoin, antimalarials, amiodarone, antipsychotics, cytotoxic drugs, tetracyclines and heavy metals.

Some drugs can cause fixed drugs eruption, which is followed by located hyperpigmentation and gradually fades.

Drug-induced pigmentation

drug-pigt1__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildfd-9897089-9361425

Minocycline pigmentation

drug-pigt3__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisinkildg1xq-3349216-4803654

Minocycline pigmentation

drug-pigt2__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildvd-8203428-5475579

Fixed drug reaction to trimethoprim + sulfamethoxazole

drug-pigt4__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildfd-7903834-7385690

since

drug-pigt5-s__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildfd-4091196-3412728

Reaction to medications

carot2__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildfd-6046312-2268975

Antiepileptic carotenemia

What causes drug-induced skin pigmentation?

Several mechanisms may be involved in drug-induced skin pigmentation changes.

  • Certain heavy metals, such as iron, silver, and gold, can deposit in the dermis next damage to dermal vessels. If deposited in sufficient quantities, a distinctive change in skin color can be seen without any significant increase in melanin.
  • Some drugs react with melanin to form a drug.pigment complex. Exposure to sunlight often stimulates sun-induced melanin synthesis forming these complexes.
  • Some drugs induce hypermelanosis (accumulation of melanin) as a nonspecific post-inflammatory change in predisposed individuals. This is often made worse by sun exposure.
  • Some drugs induce pigmentation directly by accumulating and/or reacting with other substances in the skin.

What are the clinical characteristics of drug-induced skin pigmentation?

The clinical characteristics of drug-induced skin pigmentation are highly variable depending on the drug involved. A wide range of patterns and shades can be formed.

Drug/drug groupClinical features
Heavy metals
  • Heavy metal pigmentation toxicity can be permanent
  • Iron can cause dark brown pigmentation (siderosis) at the accident site subcutaneous injection
  • Excessive gold, previously used in the treatment of rheumatic diseases, can cause diffuse golden brown pigmentation
  • Ingested silver salts can induce diffuse grayish pigmentation (argyria)
Tetracyclines (minocycline)
  • Bluish pigmentation, especially in scars
  • Can affect nail and skin
  • Cumulative; pigmentation is more likely at higher doses
  • It affects older patients more than younger ones.
  • It may take several years to disappear once the medication is stopped.
Antipsychotics (chlorpromazine and related phenothiazines)
  • Blue-gray pigmentation, especially in sun-exposed areas
  • The pigmentation is cumulative and some areas may develop a purplish tint.
  • Pigmentation of the conjunctiva in the eye can also occur, along with waterfalls and corneal opacities
Phenytoin/anticonvulsants
  • 10% patients develop pigmentation of the face and neck that resembles chloasma (clearly defined, approximately symmetrical dark brown patches)
  • It fades after a few months when the medication is stopped.
Antimalarials
  • About 25% of patients receiving chloroquine or hydroxychloroquine for several years develop bluish-gray pigmentation on the face, neck, and sometimes the legs and forearms.
  • Long-term continuous use may result in blue-black spots, especially in sun-exposed areas.
  • Nail beds and changes in the cornea and retina may also develop.
Cytotoxic drugs
  • Busulfan, cyclophosphamide, bleomycin, and adriamycin have produced hyperpigmentation to some degree.
  • Banded or diffuse pigmentation of the nails often occurs
Amiodarone
  • Blue-gray pigmentation in sun-exposed areas (face and hands)
  • Photosensitivity occurs in 30-57% of patients, while 1-10% shows skin pigmentation
  • Skin pigmentation is reversible, but may take up to a year for complete resolution after stopping the medication.
NSAID
  • Often associated with fixed drugs rashes (drugs that cause a single or few acute demarcated erythematous lesions that resolve quickly but leave local brown pigmentation
  • It can occur on the face, extremities and genitals.

What is the treatment for drug-induced skin pigmentation?

Drug-induced skin pigmentation can become cosmetically disfiguring. In many cases, once the offending drug is discontinued, discoloration of the lesions occurs. However, the pigmentation can last a long time or become permanent. Because many medications that induce skin pigmentation also cause photosensitivity reactions, sun protection is generally recommended.

To be The treatment has been successful in treating amiodarone-induced skin pigmentation.

Open chat
💬 Need help?
Hoogstra medical centers
Hello 👋How can we help you?