Diagnosis: Minocycline-induced hyperpigmentation
Hyperpigmentation is a rare but not uncommon adverse effect of long-term minocycline use. In this case, our patient had been taking minocycline for more than 5 years. When seen in our clinic, he said he could not remember why he was taking minocycline and incorrectly assumed it was for his diabetes. Chart review of outside records revealed that it had been prescribed, and refilled annually, by his primary physician for rosacea.
Minocycline hyperpigmentation is subdivided into 3 types:
- Type I manifests with blue-black discoloration in previously inflamed areas of skin.
- Type II manifests with blue-gray pigmentation in previously normal skin areas.
- Type III manifests diffusely with muddy-brown hyperpigmentation on photoexposed skin.
Furthermore, noncutaneous manifestations may occur on the sclera, nails, ear cartilage, bone, oral mucosa, teeth, and thyroid gland.1
Diagnosis focuses on identifying the source
Minocycline is one of many drugs that can induce hyperpigmentation of the skin. In addition to history, examination, and review of the patient’s medication list, there are some clues on exam that may suggest a certain type of medication at play.
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