Minocycline hyperpigmentationT78.9
Synonym(s)
DefinitionThis section has been translated automatically.
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).
Occurrence/EpidemiologyThis section has been translated automatically.
Hyperpigmentation occurs in up to 15% of patients undergoing long-term treatment, depending on the cumulative dose.
EtiopathogenesisThis section has been translated automatically.
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.
Clinical featuresThis section has been translated automatically.
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.
HistologyThis section has been translated automatically.
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.
DiagnosisThis section has been translated automatically.
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.
TherapyThis section has been translated automatically.
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.
LiteratureThis section has been translated automatically.
- Asakura Tet al. (2016) Blue-Black Trachea as a Result of Minocycline-induced Hyperpigmentation. On J Respir Crit Care Med 193:e5-6.
- Ballard TN et al (2016) Minocycline-induced orbital rim discoloration. J AAPOS. 20:182-184.
- Friedman IS et al (2002) Minocycline-induced hyperpigmentation of the tongue: successful treatment with the Q-switched ruby laser. Dermatol Surgery 28: 205-209
- Gauer CC et al (2015) Blue-black eyes and legs. Lancet doi: 10.1016/S0140-6736(14)61800-6.
- Hanada Y et al. (2016) Minocycline-Induced Cutaneous Hyperpigmentation in an Orthopedic Patient Population. Open Forum Infect Dis. 3: ofv107.
- Jung JJ et al (2016) Swept-Source Optical Coherence
- Katz J (2001) Use of minocycline and soft tissue pigmentation: close association. Arch Dermatol 137: 372
- Pepine M et al (1993) Extensive cutaneous hyperpigmentation caused minocycline. J Am Acad Dermatol 28: 292-295
- Tomography and OCT Angiography of Minocycline-Induced Retinal and Systemic Hyperpigmentation. Ophthalmic Surg Lasers Imaging Retina 47:356-361
- Nenoff Pet al. (2015) Diffuse grey-black hyperpigmentation of facial skin in a 59-year-old woman. dermatologist 66:214-217
- Siller GM et al (1994) Minocycline-induced oral pigmentation. J Am Acad Dermatol 30: 350-354
- Stichman JR et al (2016) Minocycline-induced Cartilage Hyperpigmentation Mimicking Alkaptonuria in a Patient with Knee Pain. J Rheumatol 43:825.