tetracycline and Hyperpigmentation

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

Topics: Bone and Bones; Hyperpigmentation; Pigmentation Disorders; Tetracycline; Toxicology

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

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

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Doxycycline; Drug Eruptions; Drug Therapy, Combination; Female; Humans; Hyperpigmentation; Tetracycline

Topics: Anti-Bacterial Agents; Conjunctival Diseases; Humans; Hyperpigmentation; Male; Middle Aged; Tetracycline