Doxycycline-Associated Hyperpigmentation: A Case Report and Literature Review

Abstract

Drug-induced hyperpigmentation is an adverse cutaneous effect; it has been associated with several systemic medications. A healthy 40-year-old man developed facial and dorsal hand hyperpigmentation within two weeks of beginning doxycycline monohydrate 100 milligrams twice daily for acne. Skin pigmentation significantly diminished at a follow-up evaluation two months after discontinuing the medication. Doxycycline-associated skin hyperpigmentation, albeit uncommon, has been described in 18 patients in the literature, including our patient. The demographics included 13 males and five females ranging in age from 11 to 87 years; eight of the patients were less than 50 years old and ten of the patients were over 60 years old. Doxycycline-associated hyperpigmentation frequently occurs on the face and can occur at the site of a previous scar. In most cases, doxycycline was discontinued with the resolution of hyperpigmentation.

Phase 2 Trial Evaluating Minocycline for Geographic Atrophy in Age-Related Macular Degeneration

“…It is considered harmless but has cosmetic relevance. It typically resolves slowly over time, with drug cessation …”

“…Skin hyperpigmentation/discoloration was a relatively common occurrence, particularly in the later study years. This is a known AE of minocycline . It arises from iron and melanin accumulation extracellularly and within macrophages in the dermis.…”

“…This is a known AE of minocycline. [37][38][39] It arises from iron and melanin accumulation extracellularly and within macrophages in the dermis. It is considered harmless but has cosmetic relevance.…”

“…It typically resolves slowly over time, with drug cessation. 37,40 Abnormalities in thyrotropin levels were also relatively common. One participant developed Hashimoto thyroiditis, considered unrelated to minocycline.…”

Trifarotene 0.005% Cream in the Treatment of Facial and Truncal Acne Vulgaris in Patients with Skin of Color: a Case Series

“…Compared with facial AV, clinical experience suggests that PIH from truncal AV has a tendency to be more persistent. Furthermore, a recent case report and literature review has reported drug-induced hyperpigmentation associated with doxycycline monohydrate 100 mg twice daily (BID), but it was concluded to be uncommon and, in most cases, resolved after doxycycline was discontinued [ 19 ]. Notably, a review of the published photographs in the aforementioned reference of doxycycline-induced hyperpigmentation showed more diffuse hyperpigmentation that is distinct from the focal follicular/perifollicular PIH that is characteristically associated with AV.…”