Amiodarone drug-induced pigmentation
See also in: External and Internal EyeAlerts and Notices
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Synopsis

Amiodarone is a class III antiarrhythmic, iodine-rich drug that is commonly used for a wide variety of cardiac arrhythmias. Amiodarone causes a wide range of adverse effects including skin pigmentation, corneal deposits, and complications of the liver and lungs. There can also be alterations of thyroid function.
Skin effects – Blue-gray pigmentation of sun-exposed skin is common. Skin effects also include vasculitis and photosensitivity (30%-50% of patients on amiodarone). Skin pigmentation can develop 6 months to 5 years after beginning therapy.
Ocular effects – Amiodarone will induce mitochondrial deposits in the deep epithelial layer of the cornea. These deposits will form a whorl-like epitheliopathy called "corneal verticillata," or vortex keratopathy. The deposits are barely visible without the aid of a slit lamp and rarely result in any reduction in vision or ocular discomfort. The corneal verticillata are typically found on routine eye exam and are not an indication for discontinuation of the medication. Most patients using amiodarone will develop corneal deposits. Upon discontinuation of the medication, the deposits typically resolve.
Thyroid effects – Adverse events include either hypothyroidism or hyperthyroidism with skin manifestations of myxedema.
Skin effects – Blue-gray pigmentation of sun-exposed skin is common. Skin effects also include vasculitis and photosensitivity (30%-50% of patients on amiodarone). Skin pigmentation can develop 6 months to 5 years after beginning therapy.
Ocular effects – Amiodarone will induce mitochondrial deposits in the deep epithelial layer of the cornea. These deposits will form a whorl-like epitheliopathy called "corneal verticillata," or vortex keratopathy. The deposits are barely visible without the aid of a slit lamp and rarely result in any reduction in vision or ocular discomfort. The corneal verticillata are typically found on routine eye exam and are not an indication for discontinuation of the medication. Most patients using amiodarone will develop corneal deposits. Upon discontinuation of the medication, the deposits typically resolve.
Thyroid effects – Adverse events include either hypothyroidism or hyperthyroidism with skin manifestations of myxedema.
Codes
ICD10CM:
T50.995A – Adverse effect of other drugs, medicaments and biological substances, initial encounter
SNOMEDCT:
110284009 – Drug-induced pigmentation
T50.995A – Adverse effect of other drugs, medicaments and biological substances, initial encounter
SNOMEDCT:
110284009 – Drug-induced pigmentation
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Drug-induced pigmentation
- Drug-induced pigmentation, flagellate
- Drug-induced pigmentation, minocycline
- Melasma (chloasma)
- Post-inflammatory hyperpigmentation has history of preceding inflammation.
- Phytophotodermatitis
- Fixed drug eruption
- Large plaque parapsoriasis
- Generalized hyperpigmentation is also seen in Addison disease, Cushing syndrome, scleroderma, Wilson disease, hemochromatosis, chronic renal failure, porphyria cutanea tarda, vitamin B12 deficiency, pellagra, ochronosis, Gaucher disease, and carcinoid syndrome.
- Erythema ab igne
- Ashy dermatosis (erythema dyschromicum perstans)
- Confluent and reticulated papillomatosis (Gougerot-Carteaud syndrome)
- Cutaneous T-cell lymphoma
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
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References
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Last Updated:02/20/2018

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Amiodarone drug-induced pigmentation
See also in: External and Internal Eye