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Minocycline Hyperpigmentation

      An elderly man with a history of stage I lentigo maligna melanoma of the right jawline was followed up regularly in the dermatology clinic for skin cancer surveillance. During his visits, progressive, asymptomatic discoloration of his head, neck, and distal aspect of the lower extremities was incidentally noted. Physical examination findings included bluish gray hyperpigmented patches of the face and neck, legs, and sclera, consistent with a diagnosis of minocycline-induced hyperpigmentation. Six years earlier, the patient had undergone resection of an infected left knee implant followed by total knee reimplantation; postoperatively, long-term suppressive therapy with minocycline was initiated. He was not bothered by the pigmentary changes of his skin, and given the risks associated with reinfection, continued lifelong use of minocycline was recommended by the orthopedic surgeon.
      Minocycline hyperpigmentation is divided into 3 types: blue-black discoloration in areas of prior inflammation, such as acne scars (type I); blue-gray pigmentation of previously normal areas of skin, such as the anterior aspect of the lower legs (type II); and uncommonly, diffuse muddy brown hyperpigmentation that is accentuated in sun-exposed areas (type III).
      • James W.D.
      • Elston D.M.
      • Berger T.G.
      The incidence of types II and III minocycline hyperpigmentation increases with total cumulative dose.
      • James W.D.
      • Elston D.M.
      • Berger T.G.
      In addition to the skin, minocycline pigmentation can also affect the sclera, nails, ear cartilage, bone, oral mucosa, teeth, and thyroid gland.
      • James W.D.
      • Elston D.M.
      • Berger T.G.
      The cutaneous hyperpigmentation may take months to years to fade after minocycline use is discontinued, and laser therapy can be used to improve the discoloration.
      • James W.D.
      • Elston D.M.
      • Berger T.G.

      Reference

        • James W.D.
        • Elston D.M.
        • Berger T.G.
        Andrews' Diseases of the Skin: Clinical Dermatology. 11th ed. Saunders/Elsevier, London, UK2011: 126