Amiodarone drug-induced pigmentation
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.
T50.995A – Adverse effect of other drugs, medicaments and biological substances, initial encounter
110284009 – Drug-induced pigmentation
Differential Diagnosis & Pitfalls
- Drug-induced pigmentation
- Drug-induced pigmentation, flagellate
- Drug-induced pigmentation, minocycline
- Melasma (chloasma)
- Post-inflammatory hyperpigmentation has history of preceding inflammation.
- 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
Drug Reaction Data