Minocycline hyperpigmentation T78.9

Relatively frequent side effect of long-term therapy (e.g. acne or rosacea) with the tetracycline derivative Minocycline. The changes are dose-dependent (exceeding a cumulative total dose of > 100g).

Hyperpigmentation occurs in up to 15% of patients undergoing long-term treatment, depending on the cumulative dose.

Dose-dependent deposits of minocycline-iron chelate complexes and melanin deposits are discussed. These occur not only in the skin (particularly prominent in scars) but also in the nails, conjunctiva, sclerae, mucous membranes of the palate and cartilage, bones, cartilage, teeth, brain, thyroid and heart.

Four types are described:

• Type I: Blue-black hyperpigmentation mainly in pre-existing scars, especially in the face after previous inflammation.
• Type II: Macular or diffuse hyperpigmentation on normal skin.
• Type III: Dirty-brown hyperpigmentation on sun-exposed skin
• Type IV: Hyperpigmentations on the back in acne scars

These occur when a critical dose (cumulative dose >100g) is exceeded. They also occur in bone and cartilage. The changes are reversible, but the regression takes many months.

The pigments are found in the basal cell layer of the epidermis as well as in macrophages or exposed along connective tissue or neurogenic structures.

On skin areas exposed to sunlight; face and back of the hands; also on arms and lower legs and ankles. In some patients (e.g. acne vulgaris) hyperpigmentation occurs in inflammatory and scarred lesions.

The discoloration usually fades slowly after stopping the medication, but can persist for months. Hydroquinone-containing bleaching creams are not recommended, better are dermatologische Make-up's.

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