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Minocycline drug-induced pigmentation in Adult
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Minocycline drug-induced pigmentation in Adult

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Contributors: Erik Domingues MD, Nikki Levin MD, Jeffrey D. Bernhard MD
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Drug-induced pigmentation caused by minocycline may affect the skin, mucosal surfaces, teeth, tongue, sclera, bone, heart, thyroid, and other locations. Minocycline is a tetracycline-derived antibiotic with various uses, most notably as a second-line treatment for acne vulgaris. Hyperpigmentation may follow ingestion of 100-200 mg/day for 1-3 years, and incidence rates vary from 2.4%-14.8%. However, some studies have demonstrated the development of hyperpigmentation following small doses and short courses of minocycline.

The incidence seems highest in patients with conditions such as atopic dermatitis, acne vulgaris, rheumatoid arthritis, pemphigoid, and pemphigus.

Four types of hyperpigmentation have been described: types I–IV. Each type varies in distribution and histology. (For type details, refer to Look For section.)

Pediatric Patient Considerations:
Children aged younger than 9 years should not be on medications from the tetracycline family of antibiotics.


T50.995A – Adverse effect of other drugs, medicaments and biological substances, initial encounter

110284009 – Drug-induced pigmentation

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Immunocompromised Patient Differential Diagnosis:
  • Human immunodeficiency virus (HIV)-infected patients and AIDS patients on zidovudine may develop brown macules on the oral mucosa or lips and longitudinal brown bands on nails.

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Management Pearls

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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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Last Updated: 02/21/2018
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Minocycline drug-induced pigmentation in Adult
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Minocycline drug-induced pigmentation : Blue color, Brown color, Face, Hyperpigmented patch, Leg
Clinical image of Minocycline drug-induced pigmentation
A close-up of pinpoint dark gray and black macules.
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