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Drug-induced pigmentation in Adult
Other Resources UpToDate PubMed

Drug-induced pigmentation in Adult

Contributors: David O'Connell MD, William Schaffenburg MD, Catherine J. Wang, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Drug-induced pigmentation and/or hyperpigmentation may be caused by numerous drugs through a number of differing mechanisms. There may be a stimulation of increased melanin production or deposition of the drug or its metabolites in the epidermis and/or dermis. Perhaps the most common reaction is postinflammatory hyperpigmentation, as typically seen following inflammatory drug eruptions or fixed drug eruptions. A further mechanism of drug-induced pigmentation is the production of new pigment such as increased lipofuscin synthesis.

Increased melanin most often produces a brownish pigmentation in the dermis. When active compounds deposit in the dermis, however, there may be associated red-brown, blue-black, blue-gray, purple, or slate discoloration.

There are certain classes of drugs that are more commonly implicated in causing skin, mucous membrane, and nail pigmentation. These include antimalarials, some antimicrobials, heavy metals, antineoplastic (chemotherapeutic) agents, and psychotropics and anticonvulsants. Antiretroviral- and diltiazem-induced skin hyperpigmentation has been reported to occur with higher frequency in individuals of African descent. NSAIDs and antiretrovirals have also been noted as causing specific pigment changes.

Related topics: drug-induced flagellate pigmentation, amiodarone drug-induced pigmentation, minocycline drug-induced pigmentation, drug-induced hypopigmentation, drug-induced oral pigmentation, drug-induced nail pigment, fixed drug eruption

Codes

ICD10CM:
L81.9 – Disorder of pigmentation, unspecified

SNOMEDCT:
110284009 – Drug-induced pigmentation

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Always keep Kaposi sarcoma in the differential diagnosis of hyperpigmentation in HIV-infected individuals (and have a low threshold to biopsy).

Nail and skin hyperpigmentation have been observed in HIV / AIDS patients independent of antiretroviral therapy. Thus, pigmentary alteration in this population may be especially difficult to attribute to drugs.

Best Tests

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Management Pearls

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Therapy

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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 Reviewed:10/22/2019
Last Updated:02/02/2021
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Drug-induced pigmentation in Adult
Drug-induced pigmentation
Clinical image of Drug-induced pigmentation
Brown and violaceous macules and patches on the dorsal hands, developing secondary to medication.
Copyright © 2021 VisualDx®. All rights reserved.