Minocycline-Induced Pigmentation

Abstract

Pigmentation is a well recognised adverse effect of minocycline therapy. Various body sites, most notably the skin, nails, bones, thyroid, mouth and eyes are affected and the pigmentation may appear at multiple sites. In general, pigmentation results from long term administration of minocycline at cumulative doses greater than 100 g, although cutaneous or oral mucosal pigmentation may appear, regardless of dose or duration of therapy. When the skin is involved, the blue-black pigmentation develops most frequently on the shins, ankles and arms. Other patterns of skin involvement include pigmentation that is either generalised and symmetrical, or that develops at sites of inflammation. The bones of the oral cavity are probably the most frequently affected sites of pigmentation affecting greater than 20% of patients taking minocycline for more than 4 years. In contrast, the oral mucous membranes and teeth are infrequently pigmented from minocycline. Ocular, thyroid and visceral pigmentation is also relatively uncommon and usually develops only with high doses and long term minocycline use. Whereas pigmentation of the skin and oral mucosa is generally reversible when the drug is discontinued, the pigmentation is often permanent when other sites are involved. Although minocycline-induced pigmentation is not harmful, the drug should be discontinued when the adverse effect is recognised. All patients receiving minocycline, especially those treated for longer than 1 year, require screening for the development of pigmentation.

Side Effects of Minocycline Treatment in Patients With Fragile X Syndrome and Exploration of Outcome Measures

“…Nail pigmentation caused by this drug is unusual and less common than skin involvement. Although a number of color changes have been reported, a slate-grey discoloration of the proximal nail bed appears to be the most frequent type, as we saw in our patient (Eisen & Hakim, 1998). Generally, pigmentation develops concomitantly with other sites of involvement and is rarely an isolated finding.…”

“…Stimulation of nail matrix melanocytes with increased melanin deposition in the nail plate has been described as the cause of pigmentation in longitudinal melanonychia secondary to minocycline. The nail pigmentation may persist for prolonged periods after withdrawal from the drug (Eisen & Hakim, 1998). There is some data from laboratory study in rats that antioxidants, such as vitamin C, will decrease the occurance of pigmentation (Bowles, 1998).…”

“…Although minocycline is prescribed widely, there are adverse effects, including staining of the teeth and oral cavity (Cascio et al, 2004; LaPorta, Nikitakis, Sindler, & Reynolds, 2005; Sanchez, Rogers, & Sheridan, 2004), a lupus-like syndrome (Akin, Miller, & Tucker, 1998; Lawson, Amos, Bulgen, & Williams, 2001; Porter & Harrison, 2003; Schlienger, Bircher, & Meier 2000; Tournigand et al, 1999), gastrointestinal disturbance (Shetty 2002), autoimmune hepatitis (Abe et al, 2003; Teitelbaum et al, 1998), pigmentation in the skin and other tissue (Eisen & Hakim, 1998), photosensitivity (Smith & Leyden 2005), and pseudotumor cerebri (Ang, Zimmerman, & Malkin, 2002). …”

Minocycline-Induced DRESS: Evidence for Accumulation of the Culprit Drug

“…Minocycline-induced pigmentation most commonly involves the skin but has been reported in numerous other sites [17]. Accumulation of minocycline has been demonstrated in minocycline-induced pigmentation of the thyroid [18] and of the skin.…”

Minocycline-Induced Hyperpigmentation in a Patient Treated with Erlotinib for Non-Small Cell Lung Adenocarcinoma

“…In addition, the tetracyclines used to treat these side effects have their own toxicities. In dermatology literature, minocycline for the treatment of acne, rosacea, and blistering diseases is well known to cause blue-black pigmentation of the skin, eyes, bones, existing scars, and teeth [4]. However, in oncology literature, there are rare reports of minocycline hyperpigmentation when used to treat EGFR inhibitor-induced papulopustular eruptions.…”