minocycline and Hyperpigmentation

In this case report, we highlight minocycline-induced scleral hyperpigmentation, combined with ear and fingernail discoloration that developed after over 15 years of use for rosacea in a 78-year-old male with multiple medical comorbidities. Minocycline, a tetracycline antibiotic, is used to treat rosacea and acne as well as some orthopedic infections. It is typically used for extended periods of time; long-term use of minocycline is associated with hyperpigmentation of the sclera, conjunctiva, retina, teeth, skin, subcutaneous fat, oral mucosa, tympanic membrane, and gingiva. This case highlights that hyperpigmentation is more likely to occur in older patients than in younger patients. Scleral hyperpigmentation is not associated with vision loss; however, cosmetic concerns can prompt discontinuation of minocycline. Nonetheless, after cessation, the lesions persist in some patients. Monitoring for hyperpigmentation in patients using minocycline is important, as the hyperpigmentation is more likely to be permanent with long-term use.

Topics: Acne Vulgaris; Aged; Anti-Bacterial Agents; Humans; Hyperpigmentation; Male; Minocycline; Rosacea; Scleral Diseases; Vision Disorders

To review the safety and efficacy of minocycline 4% topical foam for the treatment of moderate to severe acne vulgaris in adults and pediatric patients aged 9 years and older.. A literature search through PubMed and EMBASE was conducted using the following keywords:. Articles selected included those describing preclinical and clinical studies of pharmacokinetics, efficacy, or safety of topical minocycline foam.. Minocycline 4% topical foam was shown in a preclinical study to effectively deliver minocycline to the pilosebaceous unit, with little penetration beyond the stratum corneum. This was consistent with a phase 1 pharmacokinetic study of the foam, which yielded a significantly reduced systemic exposure of minocycline compared with oral minocycline. In phase 2 and phase 3 clinical trials, the foam significantly reduced acne lesion counts and Investigator's Global Assessment scores of acne severity compared with placebo. The foam has a good safety profile, with headache, mild erythema, hyperpigmentation, and mild dryness among the most common adverse effects.. Topical antibiotics have been a mainstay of acne therapy with the benefit of less systemic exposure compared with oral antibiotics. However, the development of bacterial resistance has reduced their use, thereby reducing options for many patients with acne. Minocycline 4% topical foam is a safe and effective alternative, which may help restore this important therapeutic approach for treating acne vulgaris.

Topics: Acne Vulgaris; Administration, Cutaneous; Adult; Anti-Bacterial Agents; Child; Clinical Trials as Topic; Female; Humans; Hyperpigmentation; Male; Minocycline; Treatment Outcome

Topics: Black or African American; Color; Face; Female; Humans; Hyperpigmentation; Minocycline

The aim of this study was to describe 4 patients with oral mucosa hyperpigmentation associated with 4 drug classes and to review the relevant literature.. Two patients under imatinib and hydroxychloroquine treatment exhibited diffuse palatal hyperpigmentation and 2 patients treated with minocycline and golimumab showed multifocal pigmented macules. In all cases, biopsy was performed.. Microscopically, in all cases, there was no increase in the number of melanocytes in the epithelium, and pigment granules were present in the lamina propria. The pigment granules in minocycline- and golimumab-associated hyperpigmentation were seen in the superficial lamina propria and reacted for silver but not iron, whereas in imatinib- and hydroxychloroquine-associated hyperpigmentation, pigment granules were found in the reticular lamina propria and reacted for both silver and iron. A review of the literature found 38 cases of hyperpigmentation of the oral mucosa attributed to minocycline, 23 to imatinib, 1 to hydroxychloroquine without microscopic documentation, and none to golimumab.. The temporal relationship between pigmentation and onset of drug effect, resolution following drug withdrawal, and exclusion of other causes support the diagnosis of drug-induced hyperpigmentation. Microscopic examination may be contributory to diagnosis, as there are differences among drugs with regard to the distribution of pigment granules and the histochemical reactions of the drugs.

Topics: Aged; Anti-Bacterial Agents; Antibodies, Monoclonal; Antirheumatic Agents; Biopsy; Female; Humans; Hydroxychloroquine; Hyperpigmentation; Imatinib Mesylate; Male; Middle Aged; Minocycline; Mouth Mucosa; Protein Kinase Inhibitors

Topics: Adult; Biopsy, Fine-Needle; Carcinoma; Carcinoma, Papillary; Diagnosis, Differential; Female; Humans; Hyperpigmentation; Immunohistochemistry; Minocycline; Thyroid Cancer, Papillary; Thyroid Gland; Thyroid Neoplasms; Thyroid Nodule; Thyroidectomy; Tomography, X-Ray Computed

Prurigo pigmentosa is a rare inflammatory skin disease of unknown etiology presenting as a pruritic truncal eruption of reticulated and symmetric macules and papules with the predilection for young Japanese females. Although cases of PP are increasingly reported in the non-Japanese literature, dermatologists may be unfamiliar with this entity. Here we report a Caucasian American female and a Chinese American female with PP and a discussion of the literature. The treatments of choice for prurigo pigmentosa are tetracyclines such as doxycycline and minocycline, as well as dapsone. The prognosis is excellent.

Topics: Adult; Anti-Bacterial Agents; Female; Humans; Hyperpigmentation; Minocycline; Prurigo; Treatment Outcome; United States

Minocycline is a commonly used antibiotic for long-term treatment of acne vulgaris. A well-documented and cosmetically dis-pleasing side effect is skin pigmentation. Three distinct types occur: Type I, blue-black/grey pigment on the face in areas of scarring or inflammation associated with acne; type II, blue-grey pigment on normal skin on the shins and forearms; type III, diffuse muddy-brown discoloration in areas of sun exposure. Types I and II stain for iron and melanin extracellularly and within macrophages in the dermis. Type III shows nonspecific increased melanin in basal keratinocytes and dermal melanophages staining for melanin only. The etiology of this pigmentation is unknown, but may be related to polymerized reactive metabolites, insoluble chelation products, and lengthy treatment durations of minocycline compared to other tetracyclines. Types I and II tend to resolve slowly over time, whereas type III persists indefinitely. Treatment involves early recognition, discontinuation of the drug, sun protection, and laser for persistent pigmentation.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Humans; Hyperpigmentation; Minocycline

Topics: Anti-Bacterial Agents; Diagnosis, Differential; Humans; Hyperpigmentation; Male; Melanoma; Minocycline; Skin Diseases

Minocycline is a semisynthetic broad-spectrum antimicrobial agent that was first introduced into clinical practice in 1967. The most common use of minocycline is for the long-term treatment of acne vulgaris. A well-recognized side effect of minocycline treatment is pigmentation, which has been reported in multiple tissues and fluids including thyroid, skin, nail beds, sclera, bone, and teeth. While there have been several reports of oral pigmentation following minocycline therapy, these have been, for the most part, pigmentation of the underlying bone with the overlying oral mucosa only appearing pigmented. We report two cases of actual pigmented oral mucosal lesions on the hard palate secondary to minocycline therapy with the accompanying histopathology, followed by a discussion of minocycline-induced oral pigmentation and a differential diagnosis of these lesions.

Topics: Adult; Anti-Bacterial Agents; Diagnosis, Differential; Humans; Hyperpigmentation; Male; Melanosis; Middle Aged; Minocycline; Mouth Diseases; Mouth Mucosa; Palate, Hard

Tetracyclines (TCN) were introduced in 1948 as broad-spectrum antibiotics that may be used in the treatment of many common infections in children and adults. One of the side-effects of tetracyclines is incorporation into tissues that are calcifying at the time of their administration. They have the ability to chelate calcium ions and to be incorporated into teeth, cartilage and bone, resulting in discoloration of both the primary and permanent dentitions. This permanent discoloration varies from yellow or gray to brown depending on the dose or the type of the drug received in relation to body weight. Minocycline hydrochloride, a semisynthetic derivative of tetracycline often used for the treatment of acne, has been shown to cause pigmentation of a variety of tissues including skin, thyroid, nails, sclera, teeth, conjunctiva and bone. Adult-onset tooth discoloration following long-term ingestion of tetracycline and minocycline has also been reported. The remarkable side-effect of minocycline on the oral cavity is the singular occurrence of "black bones", "black or green roots" and blue-gray to gray hue darkening of the crowns of permanent teeth. The prevalence of tetracycline and minocycline staining is 3-6%. The mechanism of minocycline staining is still unknown. Most of the reviewed literature consisted of case reports; longitudinal clinical trials are necessary to provide more information on the prevalence, severity, etiology and clinical presentation of tetracycline and TCN-derivative staining in the adult population.

Topics: Anti-Bacterial Agents; Humans; Hyperpigmentation; Minocycline; Mouth Diseases; Tetracycline; Tooth Discoloration

Minocycline-induced hyperpigmentation (MIH) is a benign condition that may persist for years despite abrogation of therapy. The Q-switched ruby laser (QSRL) has been successful in removing such lesions from the skin. To date there is no documentation of QSRL or any laser being used to treat lingual hyperpigmentation associated with minocycline therapy.. Long-term follow-up results are reported for the use of QSRL to treat lingual hyperpigmentation. The literature is reviewed comparing the use of different laser systems on MIH.. A 26-year-old woman with pigment changes of the tongue and buccal mucosa due to long-term minocycline therapy was treated with four consecutive sessions with QSRL (694 nm, 20-nsec pulse duration, and 6.5 mm spot size) at 3.6-4.0 J/cm2.. A 90% resolution was achieved after three treatments. After the final treatment the lesions were completely gone. There were no side effects reported. No new pigment was detected at follow-up.. Treatment with the QSRL is a safe and effective strategy for treating hyperpigmentation of the tongue associated with minocycline therapy.

Topics: Adult; Anti-Bacterial Agents; Female; Follow-Up Studies; Humans; Hyperpigmentation; Laser Therapy; Minocycline; Remission Induction; Time Factors; Tongue Diseases

Cutaneous pigmentation associated with minocycline ingestion is an unusual adverse effect for which few treatments have been described. Within the past few years, treatment with different Q-switched lasers has been reported in the literature. The purpose of this therapeutic intervention was to determine whether the Q-switched Alexandrite laser could clinically and histologically improve pigmentation associated with minocycline ingestion. A patient with type II minocycline pigmentation was treated with the Q-switched Alexandrite (755 nm) laser and then evaluated clinically and histologically to determine the outcome of this intervention. Treatment with the Q-switched Alexandrite (755 nm) laser provided excellent clinical and histologic clearing of minocycline pigmentation. One year after completion of laser treatment, the skin has remained clinically clear with no recurrence. The Q-switched Alexandrite laser (755 nm) should be considered for treatment of type II minocycline pigmentation.

Topics: Acne Vulgaris; Adult; Beryllium; Biopsy, Needle; Disease Progression; Female; Follow-Up Studies; Humans; Hyperpigmentation; Laser Therapy; Leg Dermatoses; Minocycline; Treatment Outcome

A 65-year-old man had cutaneous hyperpigmentation that had occurred over the previous 2 1/2 years. The hyperpigmentation was extensive and involved the sclerae, nail beds, and total body; the palms and buttocks were spared. Clinical diagnosis was suggestive of hemochromatosis or heavy metal deposition. Histologic and electron microscopic findings were consistent with lysosomal iron deposition. A careful history showed that minocycline was the cause. Its use was discontinued, and after several years the patient's pigmentation is gradually returning to normal.

Topics: Aged; Drug Eruptions; Facial Dermatoses; Humans; Hyperpigmentation; Male; Microscopy, Electron; Minocycline; Nail Diseases; Pigmentation Disorders

Narrowband ultraviolet B (NBUVB) phototherapy is an effective therapeutic option for generalized vitiligo. Previous reports showed the potential benefit of minocycline to stop disease progression in vitiligo. Meanwhile, minocycline has antioxidative, anti-inflammatory, and immunomodulating properties. There is no clinical study combining oral minocycline and NBUVB for treating generalized vitiligo. This study aims to compare the efficacy and safety of the combination treatment of NBUVB plus oral minocycline with NBUVB alone in generalized vitiligo. A randomized, double-blinded, placebo-controlled pilot study was conducted. Patients were randomly treated with either combined oral minocycline 100 mg per day plus NBUVB phototherapy or placebo plus NBUVB. All patients recieved NBUVB two times per week, for 12 weeks. The outcomes were assessed using Vitiligo Area Scoring Index score (VASI) percent change, quartile grading scale (QGS) of repigmentation, and Vitiligo Disease Activity Index (VIDA) score. Fourteen generalized vitiligo patients were included, and seven cases were assigned in each group. At week 12, the mean VASI score was decreased by 28.87% (24.15) in the minocycline group compared to 27.26% (7.98) in placebo group (p = 0.886). No significant difference was observed between both treatment modalities in QGS of repigmentation and mean VIDA score change. Two of the seven patients (29%) receiving minocycline developed hyperpigmentation, dark-brown and muddy brown discoloration, which was only confined to some vitiliginous patches. In conclusion, combination therapy with oral minocycline does not enhance the efficacy of NBUVB in generalized vitiligo. Due to the high incidence of drug-induced skin hyperpigmentation, minocycline plus NBUVB should be avoided.

Topics: Humans; Hyperpigmentation; Minocycline; Phototherapy; Pilot Projects; Treatment Outcome; Ultraviolet Therapy; Vitiligo

To evaluate the efficacy and safety of minocycline in the management of HIV-associated cognitive impairment.. We enrolled HIV-positive participants with a CD4 count of 250 to 500 cells/μL in a randomized, double-blind, placebo-controlled study. They received 100 mg of minocycline or matching placebo orally every 12 hours for 24 weeks. Cognitive function was measured using the Uganda neuropsychological test battery summary measure (U NP Sum) and the Memorial Sloan-Kettering (MSK) scale. The primary efficacy measure was the 24-week change in an average of 9 standardized U NP Sum z scores.. Seventy-three participants were enrolled. Of these, 90% were female, 49% were between the ages 30 and 39 years, and 74% had 6 or more years of education. One participant had MSK score of stage 1 (i.e., mild HIV dementia), and 72 participants had MSK stage 0.5 (i.e., equivocal or subclinical dementia) at the baseline evaluation. The minocycline effect on the 24-week change of the U NP Sum compared with placebo was 0.03 (95% confidence interval -0.51, 0.46; p = 0.37).. Minocycline was safe and well tolerated in HIV-positive individuals. However, it did not improve HIV-associated cognitive impairment.. This study provides Class II evidence that 100 mg of minocycline given orally every 12 hours for 24 weeks had no significant effect compared with placebo in the improvement of cognitive function in antiretroviral therapy-naive, HIV-positive patients.

Topics: Activities of Daily Living; Adult; AIDS Dementia Complex; Anti-Bacterial Agents; Antiretroviral Therapy, Highly Active; Cognition Disorders; Depression; Double-Blind Method; Female; Humans; Hyperpigmentation; Male; Middle Aged; Minocycline; Neuropsychological Tests; Sample Size; Treatment Outcome; Uganda; Young Adult

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Humans; Huntington Disease; Hyperpigmentation; Middle Aged; Minocycline; Neuroprotective Agents; Prevalence

Topics: Acne Vulgaris; Anti-Bacterial Agents; Ethnicity; Humans; Hyperpigmentation; Minocycline; Retrospective Studies; Tetracycline

Topics: Anti-Bacterial Agents; Humans; Hyperpigmentation; Minocycline; Tongue, Hairy

Topics: Humans; Hyperpigmentation; Minocycline

Oral tetracyclines (TCNs) are commonly prescribed for acne, but they have been shown to increase the risk of hyperpigmentation, particularly in the setting of sun exposure.. We evaluated seasonal trends in TCN-associated hyperpigmentation incidence in addition to Google search trends for hyperpigmentation-related terms.. We performed a retrospective review of acne patients seen at Massachusetts General Brigham and Women’s Hospital between 1992 and 2022. We calculated the incidence of new hyperpigmentation diagnoses for each drug cohort. We also analyzed search volume of hyperpigmentation-related terms extracted from Google Trends.. Seasonal differences in new hyperpigmentation diagnoses were identified among acne patients prescribed doxycycline (P=0.016), with peak incidence in April. In the control group of patients who had never received a TCN, diagnoses peaked in May. There were no significant seasonal differences among patients prescribed minocycline (P=0.885). There was greater search volume for hyperpigmentation-related terms in spring and summer compared to fall and winter (P<0.001). Limitations of this study include its retrospective nature and reliance on prescription and diagnosis coding data.. Our findings support the seasonal periodicity of acne-related hyperpigmentation, underscoring the importance of photoprotection counseling for patients with acne. Additionally, doxycycline may be associated with an earlier onset of hyperpigmentation, suggesting a potential benefit of considering minocycline or other alternatives to doxycycline. J Drugs Dermatol. 2023;22(11):e9-e11    doi:10.36849/JDD.7409e.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Doxycycline; Female; Humans; Hyperpigmentation; Minocycline; Retrospective Studies; Seasons; Tetracycline

Topics: Facial Dermatoses; Humans; Hyperpigmentation; Lupus Vulgaris; Minocycline; Rosacea

Topics: Anti-Bacterial Agents; Humans; Hyperpigmentation; Minocycline

Topics: Anti-Bacterial Agents; Humans; Hyperpigmentation; Minocycline; Retinal Diseases; Sclera

Topics: Anti-Bacterial Agents; Humans; Hyperpigmentation; Minocycline; Nocardia

A 73-year-old man presented to the emergency department with lethargy and influenza-like symptoms. Incidentally, prominent blue sclera and blue-grey skin discolouration to the periorbital skin, pinnae, neck, upper and lower limbs, hands, feet, fingernails and toenails were noted. His general practitioner (GP) had previously ceased amiodarone, believing it to be the causative agent. A literature search confirms the side effects were likely due to minocycline, which the patient had been taking for 10 years. Long-term minocycline use is associated with scleral and skin hyperpigmentation, with no apparent adverse effect on ocular structure or function. The pigmentation may reverse with cessation of minocycline, or it may be permanent. Amiodarone may also cause skin hyperpigmentation, but scleral pigmentation is not a known association. This case report explores the side effect profiles of these two drugs, and highlights the potential for confusion regarding causative agents when used concurrently.

Topics: Aged; Anti-Bacterial Agents; Humans; Hyperpigmentation; Male; Minocycline; Sclera; Skin

Topics: Aged; Anti-Bacterial Agents; Female; Humans; Hyperpigmentation; Minocycline; Osteomyelitis; Skin Pigmentation; Sunlight

Topics: Humans; Hyperpigmentation; Italy; Minocycline; Prurigo

Topics: Humans; Hyperpigmentation; Italy; Male; Minocycline; Prurigo

Minocycline is an oral tetracycline antibiotic that has been used to treat a variety of medical conditions. A recognized side effect of minocycline is hyperpigmentation, most commonly a cutaneous phenomenon affecting the lower extremities. In our case report, we present a patient on chronic suppressive minocycline therapy identified intraoperatively with hyperpigmentation involving an atherosclerotic carotid plaque.

Topics: Aged; Anti-Bacterial Agents; Carotid Artery Diseases; Drug Administration Schedule; Endarterectomy, Carotid; Humans; Hyperpigmentation; Male; Minocycline; Plaque, Atherosclerotic

Topics: Anti-Bacterial Agents; Humans; Hyperpigmentation; Minocycline; Prurigo

Topics: Anti-Bacterial Agents; Humans; Hyperpigmentation; Minocycline

Topics: Administration, Oral; Administration, Topical; Anti-Bacterial Agents; Diagnosis, Differential; Diet, Ketogenic; Drug Therapy, Combination; Erythema; Erythromycin; Exanthema; Female; Humans; Hyperpigmentation; Minocycline; Prurigo; Skin Cream; Treatment Outcome; Young Adult

Minocycline-induced pigmentation (MIP) is an infrequent complication of minocycline therapy, with four subtypes each with distinct clinical features and histologic staining patterns. MIP may resolve following discontinuation of minocycline therapy or it may persist indefinitely. A 64-year-old Caucasian male presented with a 6 month history of progressive blue-gray facial pigmentation distributed symmetrically over his face. One session utilizing a 755 nm picosecond Alexandrite laser resulted in immediate and significant clearance of the pigment in all treated areas. Long-term follow-up at 2 years revealed no recurrence of the MIP.

Topics: Anti-Bacterial Agents; Humans; Hyperpigmentation; Lasers, Solid-State; Low-Level Light Therapy; Male; Middle Aged; Minocycline

Topics: Aged, 80 and over; Anti-Bacterial Agents; Dose-Response Relationship, Drug; Female; Humans; Hyperpigmentation; Minocycline

Topics: Aged; Anti-Bacterial Agents; Face; Female; Gingival Diseases; Humans; Hyperpigmentation; Minocycline; Pigmentation Disorders; Rosacea

Topics: Administration, Oral; Adolescent; Biopsy, Needle; Diagnosis, Differential; Female; Humans; Hyperpigmentation; Immunohistochemistry; Minocycline; Prognosis; Prurigo; Pruritus; Severity of Illness Index; Treatment Outcome

Topics: Aged; Antirheumatic Agents; Arthritis, Rheumatoid; Humans; Hyperpigmentation; Male; Minocycline

Topics: Adolescent; Biopsy; Diagnosis, Differential; Exanthema; Exocytosis; Female; Humans; Hyperpigmentation; Lymphocytes; Minocycline; Prurigo; Skin; Skin Diseases, Papulosquamous

Topics: Adenocarcinoma, Follicular; Animals; Anti-Bacterial Agents; Autopsy; Diagnosis, Differential; Dog Diseases; Dogs; Hyperpigmentation; Lameness, Animal; Male; Minocycline; Thyroid Neoplasms

Topics: Acne Vulgaris; Anti-Bacterial Agents; Female; Humans; Hyperpigmentation; Middle Aged; Minocycline; Rosacea

Topics: Aged; Anti-Bacterial Agents; Humans; Hyperpigmentation; Male; Minocycline; Mucinosis, Follicular; Mycosis Fungoides; Scleral Diseases; Skin Neoplasms; Withholding Treatment

Topics: Aged, 80 and over; Anti-Bacterial Agents; Arthritis, Infectious; Conjunctiva; Conjunctival Diseases; Female; Humans; Hyperpigmentation; Minocycline; Sclera; Scleral Diseases

Minocycline is a derivative of tetracycline. It has been widely used in dermatology for the treatment of acne and rosacea. One of its adverse effects is pigmentation of various body tissues. Clinically, 3 main distinct types of hyperpigmentation by minocycline have been distinguished: type I, with blue-gray to black pigment on the face in areas of scarring or inflammation; type II, with blue-gray pigment on normal skin of the legs, forearms and on the shins; and type III, with a diffuse muddy-brown discoloration in areas of sun exposure. In the current report, we present the case of a 50-year old man with a history of severe acne treated with minocycline in the past, who currently complained about discoloration of his face. He had also taken colloidal silver supplements for "good health" about 16 years ago. Physical examination revealed gray-blue discoloration on the face, sclera, hard palate and back. Histologic examination showed intracellular pigment deposits in macrophages of the superficial dermis in a perivascular and an interstitial distribution. The pigment stained with Fontana-Masson and von Kossa, whereas it was Perls' iron negative. This case does not fit well into any of the previously described patterns of minocycline-related hyperpigmentation.

Topics: Acne Vulgaris; Aged; Anti-Bacterial Agents; Argyria; Dietary Supplements; Humans; Hyperpigmentation; Male; Minocycline; Mucous Membrane; Silver; Skin

Topics: Anti-Bacterial Agents; Female; Humans; Hyperpigmentation; Middle Aged; Minocycline; Scleroderma, Diffuse; Skin Ulcer; Treatment Outcome

Topics: Aged; Anti-Bacterial Agents; Diagnosis, Differential; Drug-Related Side Effects and Adverse Reactions; Humans; Hyperpigmentation; Male; Minocycline; Patient Care Management; Physical Examination

Topics: Aged; Anti-Bacterial Agents; Arthroplasty, Replacement, Knee; Face; Humans; Hyperpigmentation; Leg; Male; Minocycline; Prosthesis-Related Infections; Skin

To present a case of minocycline-induced blue scleral pigmentation and discuss the pathophysiology and differential diagnoses. The uses, mechanisms, and other adverse effects of minocycline will also be highlighted.. An elderly Caucasian male patient presented for routine ocular examination complaining of blue discoloration to the whites of his eyes. He was found to have bilateral blue scleral pigmentation and blue discoloration to various other dermal areas of his body. The blue pigmentation was also visible in the posterior segment within a scleral crescent around his right optic nerve. This pigmentation was determined to be caused by long-term use of oral minocycline.. Long-term minocycline use may induce scleral, dermal, and organ hyperpigmentation, typically blue or black in coloration. The pigmentation may reverse with discontinuation of the medication, but can also be permanent. The exact mechanism of pigment deposition remains uncertain, but several theories have been proposed. While the cosmetic appearance may be dramatic, this side effect is not known to cause any systemic or ocular morbidity.

Topics: Aged, 80 and over; Anti-Bacterial Agents; Diagnosis, Differential; Humans; Hyperpigmentation; Male; Minocycline; Sclera; Scleral Diseases; Skin Pigmentation

Topics: Anti-Bacterial Agents; Female; Humans; Hyperpigmentation; Lasers, Dye; Minocycline; Young Adult

Minocycline-induced hyperpigmentation of tissues has been documented previously, but extensive cardiovascular involvement is rarely described in literature. We report a case of marked cardiovascular hyperpigmentation resulting from approximately 4 years of minocycline exposure. We will highlight how intraoperative differentiation of minocycline-induced hyperpigmentation from more sinister causes of discoloration led to the appropriate surgical management.

Topics: Anti-Bacterial Agents; Aortic Aneurysm; Aortic Dissection; Aortic Valve; Diagnosis, Differential; Heart Valve Prosthesis Implantation; Humans; Hyperpigmentation; Intraoperative Complications; Male; Middle Aged; Minocycline; Mitral Valve; Rare Diseases; Risk Assessment

Topics: Arthritis, Infectious; Arthritis, Rheumatoid; Denosumab; Drug Therapy, Combination; Female; Humans; Hyperpigmentation; Kidney Failure, Chronic; Melanosis; Middle Aged; Minocycline; Prednisone

Topics: Anti-Bacterial Agents; Cartilage; Female; Humans; Hyperpigmentation; Middle Aged; Minocycline; Trachea

Pigmentation secondary to minocycline ingestion is an uncommon adverse event affecting 3.7-14.8% of treated individuals for which few effective therapies are available. Three patterns of minocycline pigmentation have a characteristic clinical and histological appearance. The pigment composition in each variety is different and occurs at varying skin depths. Accordingly, a tailored approach according to the type of minocycline pigmentation is crucial for treatment success. The purpose of this intervention was to evaluate the efficacy of non-ablative fractional photothermolysis in combination with the Q-switched alexandrite laser for the treatment of type I minocycline pigmentation on the face. A patient with type I minocycline pigmentation was treated with non-ablative 1550-nm fractional photothermolysis followed immediately by 755-nm Q-switched alexandrite laser and then observed clinically to determine the outcome of this modality. The patient was seen in clinic 1 month later following her single treatment session and 100% clearance of all blue facial pigment was observed. Non-ablative fractional photothermolysis in combination with the 755-nm Q-switched alexandrite laser should be considered for treatment of type I minocycline pigmentation.

Topics: Anti-Bacterial Agents; Female; Humans; Hyperpigmentation; Lasers, Solid-State; Middle Aged; Minocycline; Treatment Outcome

Black bone disease refers to the hyperpigmentation of bone secondary to prolonged usage of minocycline. We present a report of a 34-year-old man who underwent femoral shaft fracture fixation complicated by deep infection requiring debridement. The implants were removed 10 months later after long-term treatment with minocycline and fracture union. A refracture of the femoral shaft occurred 2 days after implant removal and repeat fixation was required. Intraoperatively, abundant heavily pigmented and dark brown bone callus was noted over the old fracture site. There was no evidence of other bony pathology and the appearance was consistent with minocycline-associated pigmentation. As far as we are aware, this is the first case of black bone disease affecting callus within the interval period of bone healing. We also discuss the relevant literature on black bone disease to bring light on this rare entity that is an unwelcomed surprise to operating orthopaedic surgeons.

Topics: Adult; Anti-Bacterial Agents; Bone Diseases; Bony Callus; Debridement; Femoral Fractures; Fracture Fixation, Internal; Fracture Healing; Humans; Hyperpigmentation; Male; Minocycline; Reoperation; Surgical Wound Infection; Treatment Outcome

A variety of medical conditions and medications can lead to cutaneous dyschromia. We report a case of minocycline dyschromia that had been mistakenly attributed to chronic actinic purpura.

Topics: Aged; Anti-Bacterial Agents; Coinfection; Diagnosis, Differential; Humans; Hyperpigmentation; Male; Minocycline; Opportunistic Infections; Time

Topics: Acne Vulgaris; Alkaptonuria; Anti-Bacterial Agents; Arthroscopy; Diagnosis, Differential; Humans; Hyperpigmentation; Knee Joint; Male; Middle Aged; Minocycline; Pain

This is a report of an 80-year-old man with a history of rosacea and rhinophyma treated for 15 years with oral minocycline who developed significant minocycline-induced hyperpigmentation. He also had a history of Fuchs' endothelial dystrophy and had undergone penetrating keratoplasty in the right eye. Best-corrected visual acuity was 20/60 in both eyes. Examination revealed slate-grey hyperpigmentation of his body, face, and sclera and black, confluent pigmentation in the central maculae of both eyes. Green wavelength fundus autofluorescence demonstrated speckled hyperautofluorescence in the right eye, and swept-source OCT and OCTA demonstrated pigmented epithelial detachments and significant signal blocking without choroidal neovascularization.

Topics: Administration, Oral; Aged, 80 and over; Anti-Bacterial Agents; Fluorescein Angiography; Humans; Hyperpigmentation; Male; Minocycline; Multimodal Imaging; Optical Imaging; Prospective Studies; Retinal Detachment; Retinal Pigment Epithelium; Rhinophyma; Rosacea; Tomography, Optical Coherence

Topics: Female; Humans; Hyperpigmentation; Middle Aged; Minocycline

Topics: Aged; Anti-Bacterial Agents; Endocarditis, Bacterial; Eye Color; Female; Humans; Hyperpigmentation; Minocycline; Skin Pigmentation

Topics: Anti-Bacterial Agents; Diagnosis, Differential; Drug Eruptions; Facial Dermatoses; Female; Humans; Hyperpigmentation; Middle Aged; Minocycline

A 40-year-old woman was referred by her primary care physician for evaluation after a routine physical exam revealed bilateral brownish pigmentation of the tympanic membrane. Head and neck examination in the otolaryngology clinic revealed bluish hue of both sclera, teeth, and portions of her pinnae. A hearing test revealed bilateral mild sensorineural hearing loss. The patient had a history of taking minocycline for 14 years, and the hyperpigmentation that she had is known to be a rare complication of prolonged minocycline use. However, to our knowledge, this is the first case showing photographic evidence of minocycline-induced tympanic membrane hyperpigmentation. Minocycline-induced hyperpigmentation should be considered when a patient presents with brown or blue discoloration of the tympanic membrane.

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Ear Auricle; Ear Diseases; Female; Humans; Hyperpigmentation; Minocycline; Scleral Diseases; Tympanic Membrane

Topics: Acanthosis Nigricans; Acne Vulgaris; Adult; Anti-Bacterial Agents; Biopsy; Diagnosis, Differential; Foot Dermatoses; Humans; Hyperpigmentation; Male; Minocycline; Neurodermatitis

Persistent serpentine supravenous hyperpigmented eruption (PSSHE) is a peculiar patterned eruption characterised by hyperpigmented streaks following the superficial venous network on the skin. Unlike the superficial thrombophlebitis, it is characterised by underlying vessels that are patent. It has been described most commonly after injection of chemotherapeutic drugs. We describe a 40 year old man with lepromatous leprosy who developed PSSHE subsequent to starting modified multidrug therapy--multibacillary regimen in the form of minocycline and ofloxacin.

Topics: Adult; Anti-Bacterial Agents; Clofazimine; Humans; Hyperpigmentation; Leprostatic Agents; Leprosy, Lepromatous; Male; Minocycline; Ofloxacin

Topics: Anti-Bacterial Agents; Humans; Hyperpigmentation; Male; Middle Aged; Minocycline

Topics: Acne Vulgaris; Anti-Bacterial Agents; Diagnosis, Differential; Disease Progression; Eye Color; Female; Humans; Hyperpigmentation; Hypothyroidism; Middle Aged; Minocycline; Sclera; Thyroid Hormones

A 52-year-old man presented with a progressive grey-black pigmentation of facial skin, sclera and teeth. The cause was long-term ingestion of minocycline, as confirmed by history and skin biopsy. Minocycline-induced hyperpigmentation can be divided into four main patterns based on clinical appearance, distribution, light- and electron microscopic characteristics. Some patterns can manifest within weeks of initiating therapy. One must be alert to the early signs and warn the patient about the often cosmetically disturbing and persistent minocycline-induced hyperpigmentation.

Topics: Anti-Bacterial Agents; Diagnosis, Differential; Drug Eruptions; Facial Dermatoses; Humans; Hyperpigmentation; Male; Middle Aged; Minocycline; Scleral Diseases; Tooth Discoloration

Topics: Anti-Bacterial Agents; Humans; Hyperpigmentation; Leprostatic Agents; Leprosy; Male; Middle Aged; Minocycline; Rifampin; Staining and Labeling

Minocycline is a semisynthetic broad-spectrum tetracycline used for its bacteriostatic and anti-inflammatory properties in the treatment of moderate to severe acne vulgaris. Minocycline-induced hyperpigmentation (MIH) is a well-recognized phenomenon documented to involve a wide array of anatomic locations including the skin and nails, the sclera and conjunctiva, the oral cavity, and the skeleton and cartilage, as well as within viscera and body fluids. Oral involvement typically includes the hard tissues (eg, alveolar bone, roots, crowns of teeth). We present a case of MIH of the labial, gingival, and lingual oral mucosa after only 2 weeks of treatment. Our case is unique because of the short course of minocycline treatment.

Topics: Anti-Bacterial Agents; Female; Humans; Hyperpigmentation; Minocycline; Mouth Mucosa; Time Factors; Young Adult

Topics: Aged; Antirheumatic Agents; Arthritis, Rheumatoid; Drug Eruptions; Female; Humans; Hyperpigmentation; Leg Dermatoses; Minocycline

Topics: Administration, Oral; Aneuploidy; Chromosomes, Human, Pair 15; Humans; Hyperpigmentation; Male; Minocycline; Papilloma; Skin; Skin Neoplasms; Skin Pigmentation; Treatment Outcome; Young Adult

Topics: Adult; Anti-Bacterial Agents; Humans; Hyperpigmentation; Male; Melanins; Minocycline

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Female; Humans; Hyperpigmentation; Laser Therapy; Minocycline; Thigh

Topics: Aged; Anti-Bacterial Agents; Arthritis, Rheumatoid; Humans; Hyperpigmentation; Male; Minocycline; Risk Factors; Skin

Topics: Acne Vulgaris; Administration, Oral; Adolescent; Diagnosis, Differential; Female; Humans; Hyperpigmentation; Long-Term Care; Minocycline; Nail Diseases; Onycholysis; Photosensitivity Disorders; Sunlight

Minocycline has been used in the treatment of leprosy since the demonstration of its efficacy in inhibiting Mycobacterium leprae growth in 1987. Hyperpigmentation, a well-documented adverse effect, classically shows 3 clinical and histological patterns: type I consists of blue-black pigmentation in areas of current or previous inflammation, type II consists of blue-gray pigmentation of normal skin, often seen on the legs, and type III consists of diffuse muddy-brown pigmentation accentuated on sun-exposed sites. Whereas type I hyperpigmentation stains positively for hemosiderin and type III hyperpigmentation stains positively for melanin, type II hyperpigmentation stains positively for both. We describe 2 patients with leprosy on minocycline therapy who developed multiple patches of blue-gray pigmentation within preexisting leprosy lesions. Biopsies from both patients demonstrated deposition of brownish-black pigment granules within the cytoplasm of foamy histiocytes that was highlighted by both Perls and Fontana-Masson stains. Given the clinical and histological findings in our patients, it is as yet unclear whether this coexistent type I clinical pattern and type II histopathologic pattern of pigmentation is unique to multibacillary leprosy. These findings provide support for the existence of additional subtypes of minocycline-induced hyperpigmentation that do not adhere to the classic 3-type model described.

Topics: Adult; Anti-Bacterial Agents; Female; Humans; Hyperpigmentation; Leprosy, Multibacillary; Male; Middle Aged; Minocycline

Black bone disease is a rare manifestation of long term treatment with tetracyclines. We report the case of a patient who underwent surgery for bilateral hallux valgus and was found to have black discolouration of both first rays. This was subsequently related to previous long term Minocycline use. The unique features of this case relate to the location of the discolouration and the normal physical properties of the bone and soft tissues at surgery despite heavy pigmentation. Healing is now complete and follow-up at two years confirmed excellent clinical and radiological outcomes.

Topics: Anti-Bacterial Agents; Bone Diseases; Female; Hallux Valgus; Humans; Hyperpigmentation; Incidental Findings; Metatarsal Bones; Middle Aged; Minocycline; Toe Phalanges

Topics: Adult; Anti-Bacterial Agents; Chronic Disease; Erythema Nodosum; Female; Humans; Hyperpigmentation; Minocycline; Recurrence; Tetracycline

Topics: Aged; Anti-Bacterial Agents; Australia; Diagnosis, Differential; Humans; Hyperpigmentation; Male; Minocycline; Urinary Tract Infections

Topics: Anti-Bacterial Agents; Antimalarials; Diagnosis, Differential; Humans; Hyperpigmentation; Lupus Erythematosus, Systemic; Minocycline; Mouth Diseases; Mouth Mucosa; Palate, Hard

Topics: Aged; Anti-Bacterial Agents; Diagnosis, Differential; Drug Eruptions; Facial Dermatoses; Humans; Hyperpigmentation; Male; Minocycline; Neck

Topics: Clofazimine; Dapsone; Drug Therapy, Combination; Humans; Hyperpigmentation; Leprostatic Agents; Leprosy; Minocycline; New York; Patient Preference; Rifampin

Was this a case of Addison's disease, hemochromatosis, or melanoma? Or did one of the patient's medications have something to do with it?

Topics: Addison Disease; Aged; Anti-Bacterial Agents; Comorbidity; Diagnosis, Differential; Face; Female; Humans; Hyperpigmentation; Minocycline; Rosacea; Scleral Diseases

Topics: Anti-Bacterial Agents; Aortic Valve; Humans; Hyperpigmentation; Male; Middle Aged; Minocycline; Sinus of Valsalva

Topics: Aged, 80 and over; Anti-Bacterial Agents; Anticoagulants; Diagnosis, Differential; Drug Monitoring; Ecchymosis; Female; Humans; Hyperpigmentation; Minocycline; Warfarin

Topics: Aged; Esthetics; Facial Dermatoses; Female; Humans; Hyperpigmentation; Laser Therapy; Minocycline; Patient Satisfaction; Risk Assessment; Rosacea; Severity of Illness Index; Treatment Outcome

Topics: Animals; Anti-Inflammatory Agents, Non-Steroidal; Cicatrix; Cicatrix, Hypertrophic; Disease Models, Animal; Humans; Hyperpigmentation; Minocycline; Rats; Wound Healing

Minocycline is recognized as an effective, well-tolerated therapy in rheumatoid arthritis (RA), although its use has been associated with the development of cutaneous hyperpigmentation.. To assess the clinical determinants and frequency of minocycline-induced hyperpigmentation in patients with RA.. A retrospective medical record review of all patients with RA seen in 2 academic rheumatology practices was performed to identify subjects who had received at least 1 month of continuous minocycline therapy. Patient demographics, disease characteristics, medication use, and medication side effects were abstracted from the medical record. Using Cox proportional hazards regression and restricting the analysis to the initial minocycline course, we examined the association of patient factors and concomitant medications with the development of hyperpigmentation.. Of 121 patients with at least 1 minocycline course of 30 days or more, 44 (36%) developed documented hyperpigmentation, including 33 during the initial course over a median duration of 9.1 month (range 2.2-77.8 months). Hyperpigmentation was most commonly seen on the upper and lower extremities and the head/neck region. Minocycline-induced hyperpigmentation led to the discontinuation of treatment in 3 patients, with 12 additional patients receiving a dose reduction. Increasing age was the only clinical determinant significantly associated with hyperpigmentation (HR = 1.04; 95% CI 1.00-1.07, P = 0.04). There were no significant associations of sex, weight, concomitant prednisone, or aspirin use with the development of hyperpigmentation.. Minocycline-induced hyperpigmentation is a common complication seen with minocycline use in the treatment of RA, and seems to increase with age.

Topics: Adult; Age Factors; Aged; Antirheumatic Agents; Arthritis, Rheumatoid; Female; Hospitals, University; Hospitals, Veterans; Humans; Hyperpigmentation; Male; Middle Aged; Minocycline; Nebraska; Prevalence; Proportional Hazards Models; Retrospective Studies; Risk Factors

Topics: Anti-Bacterial Agents; Humans; Hyperpigmentation; Male; Middle Aged; Minocycline; Scleroderma, Diffuse

Topics: Adult; Anti-Bacterial Agents; Drug Eruptions; Humans; Hyperpigmentation; Leg Dermatoses; Male; Minocycline; Vasculitis

Topics: Anti-Bacterial Agents; Humans; Hyperpigmentation; Male; Middle Aged; Minocycline; Polymyxin B; Skin; Tigecycline

Topics: Adult; Anti-Bacterial Agents; Female; Humans; Hyperpigmentation; Minocycline; Prurigo; Skin Diseases, Vesiculobullous

Although disfiguring hyperpigmentation is a well-defined complication of minocycline therapy, modalities to reverse the phenomenon are unpredictable. We report a case of minocycline-induced, blue-black pigmentation in a 23-year-old Hispanic man, which resolved after treatment with oral isotretinoin for acne vulgaris.

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Dermatologic Agents; Humans; Hyperpigmentation; Isotretinoin; Male; Minocycline; Skin

Minocycline has a characteristic yellow-green fluorescent emission. This fluorescence has been previously demonstrated only in type 1 minocycline-induced skin hyperpigmentation.. To investigate whether the fluorescence can be detected in other types of minocycline-induced cutaneous hyperpigmentation, and to study the possible mechanisms.. Biopsies of pigmented and nonpigmented skin from 3 patients with different types of skin hyperpigmentation induced by minocycline were analysed by light microscopy and Confocal Laser Scanning Microscope (CLSM).. A yellow-green fluorescence was observed in the hyperpigmented skin of two patients with type 2, and one patient with type 4 minocycline-induced cutaneous hyperpigmentation. No fluorescence was detected in the non-pigmented skin.. Minocycline can possibly serve as a fluorescent probe in the diagnosis of all types of minocycline-induced cutaneous hyperpigmentation.

Topics: Adolescent; Aged; Anti-Bacterial Agents; Biopsy; Female; Humans; Hyperpigmentation; Male; Microscopy, Confocal; Minocycline

Topics: Anti-Bacterial Agents; Arthritis; Female; Humans; Hyperpigmentation; Middle Aged; Minocycline; Nails; Tongue

Topics: Aged, 80 and over; Anti-Bacterial Agents; Corynebacterium Infections; Female; Humans; Hyperpigmentation; Minocycline

We present a 15-year-old girl with bilateral lower extremity discoloration of one-year duration while taking minocycline for acne vulgaris. The clinical characteristics best supported type II minocycline hyperpigmentation, but the histology revealed that the pigmentation was solely limited to the subcutaneous adipose tissue, completely sparing the dermis. Special stain for iron was negative. This is the first case to our knowledge with pigment exclusively located in the subcutaneous fat and with the unusual finding of a negative stain for iron.

Topics: Acne Vulgaris; Adipose Tissue; Adolescent; Anti-Bacterial Agents; Female; Humans; Hyperpigmentation; Minocycline; Skin

Pigmentary disorders are recognized adverse effects of the semi-synthetic tetracycline derivative antibiotic, minocycline. Three distinct types of minocycline-induced cutaneous pigmentation have been described. Type I, blue-black pigmentation confined to sites of scarring or inflammation on the face; Type II, blue-grey circumscribed pigmentation of normal skin of the lower legs and forearms; and Type III, diffuse muddy brown pigmentation of normal skin accentuated in sun-exposed areas. We report two patients with acne vulgaris with a fourth type of minocycline-induced cutaneous pigmentation. They presented with circumscribed blue-grey pigmentation within acne scars confined to the back. Histology showed pigment within dendritic cells, and extracellularly throughout the dermis. Histochemistry identified a calcium containing melanin-like substance. Iron was absent. Immunohistochemistry confirmed some pigment-containing cells to be macrophages. Electron microscopy demonstrated electron-dense granules, free and membrane-bound, within macrophages and fibroblast-like cells. Energy-dispersive X-ray analysis confirmed the presence of calcium. Iron was absent. This fourth type of cutaneous minocycline hyperpigmentation may be a variant of Type I, but based on clinical, pathological and microanalytical differences, appears to be a new entity. The pigment may be a drug metabolite-protein complex chelated with calcium, or an insoluble minocycline-melanin complex. We propose a classification of cutaneous minocycline pigmentation based on clinico-pathological criteria.

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Biopsy; Humans; Hyperpigmentation; Male; Minocycline; Skin

Cutaneous pigmentation associated with minocycline therapy is an unusual adverse effect for which few successful treatments have been described. The pigment changes may persist for years, despite cessation of therapy, and is often cosmetically disfiguring, causing significant embarrassment and psychological depression in those affected. Few safe and effective treatments have been described in the past; however, recent pigment-specific laser technology has shown promise in the treatment of this condition.. The objective was to describe a series of patients with minocycline-induced hyperpigmentation who were successfully treated with a 755-nm Q-switched alexandrite laser.. Six patients with minocycline-induced hyperpigmentation on the face or legs were treated with a Q-switched alexandrite laser on a bimonthly basis until pigmentation was eradicated.. Cutaneous pigmentation resolved completely in all patients in an average of four laser sessions. Side effects were limited to transient purpura and mild desquamation without scarring or dyspigmentation.. Minocycline-induced cutaneous pigmentation can be effectively cleared without risk of adverse sequelae by Q-switched alexandrite (755-nm) laser irradiation.

Topics: Adult; Anti-Bacterial Agents; Beryllium; Female; Humans; Hyperpigmentation; Laser Therapy; Male; Middle Aged; Minocycline

Alkaptonuria, a rare autosomal-recessive disorder caused by mutations in the HGD gene and a deficiency of homogentisate 1,2-dioxygenase, is characterized by accumulation of homogentisic acid (HGA), ochronosis, and destruction of connective tissue resulting in joint disease. Certain medications have been reported to cause cutaneous hyperpigmentation resembling that of alkaptonuria. We present 5 such cases. Eighty-eight patients with a possible diagnosis of alkaptonuria were examined at the National Institutes of Health Clinical Center between June 2000 and March 2004. The diagnosis of alkaptonuria was confirmed or ruled out by measurement of HGA in the urine. Five patients with findings consistent with ochronosis, including pigmentary changes of the ear and mild degenerative disease of the spine and large joints, were diagnosed clinically as having alkaptonuria, but the diagnosis was withdrawn based on normal urine HGA levels. All 5 patients were women who had taken minocycline for dermatologic or rheumatologic disorders for extended periods. Minocycline-induced hyperpigmentation should be considered in the differential diagnosis of ochronosis. This could be of increased significance now that minocycline and other tetracyclines have been proposed as therapeutic options for rheumatoid arthritis, bringing a new population of patients with ochronosis and arthritis to medical attention with the potential, but incorrect, diagnosis of alkaptonuria.

Topics: Abscess; Acne Vulgaris; Adult; Aged; Alkaptonuria; Arthralgia; Arthritis, Rheumatoid; Diagnosis, Differential; Facial Dermatoses; Female; Humans; Hyperpigmentation; Middle Aged; Minocycline; Radiography

Topics: Adult; Anemia, Iron-Deficiency; Biopsy; Criminology; Drug Eruptions; Female; Ferric Compounds; Humans; Hyperpigmentation; Injections, Intramuscular; Male; Middle Aged; Minocycline; Rosacea; Silver Nitrate; Skin; Theft

Prurigo pigmentosa is a rare inflammatory dermatosis of unknown etiology characterized by recurrent, pruritic erythematous papules and gross reticulate hyperpigmentation. It is seen most commonly among young adult Japanese females. Only 20 cases have been described outside Japan.. We report two female, Turkish patients aged 20 and 26 years who had a pruritic rash with the characteristic clinical appearance and supportive histopathology of prurigo pigmentosa.. They were successfully treated with minocycline and doxycycline.. Prurigo pigmentosa is a relatively new clinical entity, and we believe that a more widespread knowledge of this disease will lessen its misdiagnosis. We find it noteworthy to point out that there may be a predisposition to prurigo pigmentosa amongst the Turkish and Sicilian populations.

Topics: Adult; Anti-Bacterial Agents; Doxycycline; Female; Humans; Hyperpigmentation; Minocycline; Prurigo

Prurigo pigmentosa is rather frequently observed in Japan. By contrast, this skin disease has so far rarely been reported in German speaking countries or elsewhere in Europe. In order to make the European dermatologists familiar with this peculiar skin disease, the epidemiological features as well as the clinical and histopathological findings are reviewed. The disease can be discriminated from prurigo simplex subacuta by the typical reticular hyperpigmentation, by the sparing of arms and legs and by the response to treatment with dapsone or minocycline. Additional differential diagnostic possibilities include lichen amyloidosus and confluent and reticulate papillomatosis of Gougerot-Carteaud. Diabetes or malnutrition may represent etiological factors. Because this unusual skin disease may also occur in Europe, dermatologists here should include prurigo pigmentosa in the differential diagnosis of acquired pigmentary disorders.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Anti-Infective Agents; Anti-Inflammatory Agents, Non-Steroidal; Biopsy; Dapsone; Diagnosis, Differential; Female; Humans; Hyperpigmentation; Incontinentia Pigmenti; Male; Middle Aged; Minocycline; Prurigo; Recurrence; Skin; Time Factors

Topics: Anti-Bacterial Agents; Humans; Hyperpigmentation; Minocycline; Tongue Diseases

We present a case of prurigo pigmentosa associated with vesicles that we call 'vesicular prurigo pigmentosa'. The subject was treated using minocycline with good results and no recurrence of the lesions over a 2-year period.

Topics: Adult; Anti-Bacterial Agents; Humans; Hyperpigmentation; Male; Minocycline; Prurigo; Skin; Skin Diseases, Vesiculobullous

Topics: Adult; Calcitriol; Diagnostic Errors; Follow-Up Studies; Hand Dermatoses; Humans; Hyperpigmentation; Male; Minocycline; Papilloma; Regional Blood Flow; Skin; Skin Diseases, Vascular; Skin Neoplasms; Treatment Failure

Topics: Adult; Anti-Bacterial Agents; Female; Humans; Hyperpigmentation; Minocycline; Tongue Diseases

Topics: Anti-Bacterial Agents; Diabetes Mellitus, Type 1; Humans; Hyperpigmentation; Leg Ulcer; Male; Middle Aged; Minocycline; Prognosis; Staphylococcal Infections

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Female; Humans; Hyperpigmentation; Minocycline; Tongue

Immunosuppressive medications typically used to treat the immunobullous disorders pemphigus vulgaris, pemphigus foliaceous, and bullous pemphigoid can have serious adverse effects. The tetracycline family of antibiotic drugs has been shown to be effective in the treatment of these conditions with a more favorable side effect profile. Minocycline hydrochloride use has been associated with various forms of hyperpigmentation, and its incidence is well reported in acne vulgaris and rheumatoid arthritis. We examined a series of 9 patients treated with minocycline for pemphigus or pemphigoid, most of whom have developed cutaneous hyperpigmentation.. Seven of 9 patients treated with minocycline, 50 mg daily (1 patient) or 100 mg twice daily (8 patients), for pemphigus vulgaris, pemphigus foliaceous, or bullous pemphigoid developed hyperpigmentation, which necessitated discontinuing therapy. Five of these patients had experienced notable clinical improvement of their immunobullous disease with minocycline therapy. The average duration of treatment was 8.2 months (range, 1-25 months). The second most common adverse effect in our group was oral candidiasis, which occurred in 2 patients.. We found a favorable response to minocycline therapy in 5 of 9 patients. However, 7 patients developed localized hyperpigmentation as early as 1 month after starting medication use. This incidence of minocycline-induced hyperpigmentation is significantly higher in immunobullous disease than in acne vulgaris or rheumatoid arthritis. This increased incidence may be related to an increase in pigment deposition complexed with collagen during the remodeling process, subclinical inflammation, or glucocorticosteroid-induced skin fragility. The hyperpigmentation process was reversible, as most of our patients had fading of their pigmentation after minocycline cessation.

Topics: Adult; Aged; Anti-Bacterial Agents; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Humans; Hyperpigmentation; Male; Middle Aged; Minocycline; Pemphigoid, Bullous; Pemphigus; Skin

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Biopsy, Needle; Connective Tissue Diseases; Elastic Tissue; Face; Female; Humans; Hyperpigmentation; Minocycline

A common adverse effect of minocycline therapy is cutaneous pigmentation. We describe two patients who presented with hyperpigmentation caused by minocycline. One patient, aged 54 years, had taken minocycline due to lung silicosis for 3 years before black pigmentation of the face occurred. The other 49 year-old patient developed grey-black hyperpigmentation on both lower legs after a 6-month therapy with minocycline for folliculitis. This patient was treated with the Q-switched ruby laser and the pigmentation resolved in the treated area. The different clinical and histological forms of minocycline-induced hyperpigmentation are discussed.

Topics: Administration, Oral; Anti-Bacterial Agents; Antibiotic Prophylaxis; Drug Eruptions; Folliculitis; Humans; Hyperpigmentation; Long-Term Care; Male; Microscopy, Electron; Middle Aged; Minocycline; Silicosis; Skin

Cutaneous hyperpigmentations are well-documented, but nevertheless rare side-effects of high-dose or long-term minocycline therapy. The pigmental changes, may last for years, even though therapy has been abrogated. To date, no safe and effective therapy has been described to target this cosmetically disturbing sequela.. A 57-year-old female patient with extensive pigmental changes of the face due to long-term minocycline therapy was treated in eight consecutive sessions with the Q-switched Nd:YAG-laser (1,064-nm wavelength, 5- to 7-nsec impulse length).. A 90% resolution of the pigmentation could be achieved after five treatments. After the last session the lesions were completely gone; no hypopigmentation scars, or other side-effects were observed.. Treatment with the Q-switched Nd:YAG laser seems to be an effective, safe, and easily applicable strategy for the therapy of minocycline-induced hyperpigmentations.

Topics: Aluminum Silicates; Anti-Bacterial Agents; Facial Dermatoses; Female; Humans; Hyperpigmentation; Laser Therapy; Middle Aged; Minocycline; Neodymium; Remission Induction; Safety; Yttrium

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Female; Humans; Hyperpigmentation; Male; Minocycline; Mouth Diseases

Topics: Felty Syndrome; Humans; Hyperpigmentation; Leg Injuries; Male; Middle Aged; Minocycline; Skin Transplantation

Topics: Drug Eruptions; Female; Humans; Hyperpigmentation; Middle Aged; Minocycline

A 36-year-old man was treated with dapsone, rifampicin and clofazimine for borderline lepromatous leprosy. After 9 months, his leprosy plaques became progressively more red and after 23 months, the clofazimine was stopped and he was given minocycline instead. Six weeks later, he developed blue-black pigmentation in his leprosy lesions. The histology was consistent with minocycline-induced hyperpigmentation. This is the first report of minocycline-induced pigmentation in leprosy. We suggest it is important to consider this side-effect before the administration of minocycline in leprosy, particularly if it is prescribed in place of clofazimine.

Topics: Adult; Anti-Bacterial Agents; Humans; Hyperpigmentation; Leprosy, Lepromatous; Male; Minocycline

Topics: Adolescent; Adult; Female; Humans; Hyperpigmentation; Male; Minocycline; Prurigo

We report six cases of confluent and reticulated papillomatosis in which the skin lesions cleared almost completely after treatment with minocycline. Patients with confluent and reticulated papillomatosis often do not respond well to a variety of therapeutic agents. The response of confluent and reticulated papillomatosis to minocycline was first described in 1965. Although the pharmacologic mechanisms of minocycline in confluent and reticulated papillomatosis are unknown, we suggest that it should be considered as a first-choice therapeutic agent because of its marked effectiveness.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Female; Follow-Up Studies; Humans; Hyperpigmentation; Male; Minocycline; Neoplasm Recurrence, Local; Papilloma; Skin Neoplasms; Treatment Outcome

Topics: Aged; Anti-Bacterial Agents; Humans; Hyperpigmentation; Laser Therapy; Male; Minocycline; Skin

Topics: Anti-Bacterial Agents; Female; Humans; Hyperpigmentation; Laser Therapy; Middle Aged; Minocycline

Topics: Adult; Anti-Bacterial Agents; Chemical and Drug Induced Liver Injury; Drug Eruptions; Female; Humans; Hyperpigmentation; Minocycline

Topics: Adult; Anti-Bacterial Agents; Foot Dermatoses; Humans; Hyperpigmentation; Male; Minocycline

Minocycline can cause hyperpigmentation of the conjunctiva, oral mucosa, and skin. Pigmentation of the oral mucosa may also be associated with a variety of endogenous or exogenous factors. Lingual pigmentation may be seen in Addison's disease, amalgam tatoo, malignant melanoma, Peutz-Jegher's syndrome, and other diseases. Two women who had isolated pigmentation of the tongue while taking minocycline are described; no other drug-induced pigmentation of their oral mucosa or skin occurred. Minocycline-induced pigmentation should be added to the differential diagnosis of isolated lingual hyperpigmentation.

Topics: Acne Vulgaris; Adult; Female; Humans; Hyperpigmentation; Middle Aged; Minocycline; Mouth Mucosa; Rosacea; Tongue Diseases

Minocycline hydrochloride is a semisynthetic tetracycline derivative used widely for the treatment of acne vulgaris. Among its side effects is the ability to pigment many tissues particularly thyroid, skin, tooth, and bone. A case is presented in which long-term minocycline therapy (500 g taken orally over 11 years) resulted in dark bone pigmentation (black bone disease) severe enough to be visible through the alveolar and palatal mucosa. No skin or tooth pigmentation was present.

Topics: Acne Vulgaris; Adult; Alveolar Process; Female; Humans; Hyperpigmentation; Minocycline

A 70-year-old man developed hyperpigmentation of his forearms, hands, fingernails, sclerae, ears, and teeth after 9 years of therapy with minocycline for acne rosacea. Minocycline is widely used in the treatment of acne vulgaris and uncommonly produces the side effect of hyperpigmentation. This effect does not appear to be dose-dependent and usually resolves within months to years after discontinuation of therapy. Discoloration of adult teeth, however, is generally permanent.

Topics: Aged; Humans; Hyperpigmentation; Male; Minocycline; Pigmentation Disorders; Tooth Discoloration

Topics: Adult; Etretinate; Female; Humans; Hyperpigmentation; Male; Minocycline; Papilloma; Skin Neoplasms

Minocycline-associated hyperpigmentation is an uncommon side effect. We report the case of a patient with pyoderma gangrenosum successfully treated with oral minocycline but complicated by marked hyperpigmentation in his pyoderma gangrenosum and acne scars. One of the clinical forms of minocycline hyperpigmentation includes dark-blue or black macules in depressed acne scars or other sites of skin inflammation; this pattern seems to be independent of the total cumulative dose and the skin process.

Topics: Adult; Humans; Hyperpigmentation; Male; Minocycline; Pyoderma Gangrenosum

Topics: Adult; Drug Eruptions; Female; Humans; Hyperpigmentation; Lip Diseases; Minocycline

Oral mucosal pigmentation is an infrequently reported side effect of minocycline. Two patients with minocycline deposition within teeth and bone, demonstrated by fluorescence microscopy, are described. Minocycline is the only tetracycline reported to cause discoloration of the oral mucosa. This may be the result of deposition of an insoluble degradation product of minocycline in the underlying bone. Pigmentation is not necessarily dose-dependent and may take months or years to resolve.

Topics: Adult; Alveolar Process; Color; Female; Gingival Diseases; Humans; Hyperpigmentation; Minocycline; Mouth Diseases; Mouth Mucosa; Palate

Topics: Acne Vulgaris; Adolescent; Female; Humans; Hyperpigmentation; Middle Aged; Minocycline

The authors report a case of cutaneous pigmentation induced by minocycline. The patient (aged 59) presented with a bluish-grey pigmentation on her face, legs and nails. She had been receiving minocycline for 8 years for asthma. The cumulative dose was 400 g. Skin biopsy specimens from the pigmented areas were examined by light and electron microscopy. Light microscopy displayed hyperpigmentation with Fontana's stain in the dermis, macrophages and basal layer of the epidermis. Electron microscopy showed an increase in melanosomes within the basal keratinocytes, and dense granules in macrophages of the dermis. An X-ray microanalysis of the electron-dense granules showed the presence of larger quantities of iron and smaller quantities of sulphur and calcium. The different types of pigmentation are reviewed. Several pigments are thought to be responsible for the pigmentation but the underlying mechanism remains unclear.

Topics: Female; Humans; Hyperpigmentation; Macrophages; Melanins; Middle Aged; Minocycline; Spectrometry, X-Ray Emission; Spectrum Analysis