Drug-induced pigmentation or dyspigmentation represents 10%-20% of all cases of acquired hyperpigmentation. Mechanisms of drug-induced pigmentation include cutaneous deposition of the drug or its metabolites, accumulation of melanin, deposition of iron, or synthesis and deposition of special pigments such as lipofuscin. Increased melanin produces brown pigmentation. When medications are deposited in the dermis, they can cause blue-black or muddy brown macules. Drugs commonly associated with hyperpigmentation include NSAIDs, antimalarials, psychotropic medications, amiodarone, bleomycin, tetracyclines (most commonly minocycline), chemotherapeutic agents, and metals such as silver and gold.
Minocycline-induced pigmentation is of special note as it has been among the most widely used of these medications in adolescents, as a primary antibiotic choice in the treatment of moderate to severe acne vulgaris. Usually, the pigmentation develops after a year or more of therapy, but it has been reported to occur after just a few weeks to a couple of months.
Related topics: drug-induced flagellate pigmentation, amiodarone drug-induced pigmentation, drug-induced hypopigmentation, drug-induced oral pigmentation, drug-induced nail pigment, fixed drug eruption
Drug-induced pigmentation in Child
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Synopsis
Codes
ICD10CM:
L81.9 – Disorder of pigmentation, unspecified
T50.905A – Adverse effect of unspecified drugs, medicaments and biological substances, initial encounter
SNOMEDCT:
110284009 – Drug-induced pigmentation
L81.9 – Disorder of pigmentation, unspecified
T50.905A – Adverse effect of unspecified 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
- Postinflammatory hyperpigmentation has history of preceding inflammation.
- Phytophotodermatitis
- Jaundice causes a yellow cast to the skin; it can also be drug induced.
- Confluent and reticulated papillomatosis (Gougerot-Carteaud syndrome)
- Erythema ab igne
- Carotenemia causes a yellow-orange color in the skin.
- Lycopenemia causes an orange color in the skin.
- Generalized hyperpigmentation is also seen in Addison disease, Cushing syndrome, vitamin B12 deficiency, pellagra, ochronosis, Gaucher disease, carcinoid syndrome, Nelson syndrome, ectopic ACTH syndrome, adrenoleukodystrophy, and primary biliary cirrhosis.
- Ashy dermatosis (erythema dyschromicum perstans)
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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:01/17/2023
Last Updated:01/18/2023
Last Updated:01/18/2023
Drug-induced pigmentation in Child