Persistent severe amiodarone-induced photosensitivity

Abstract

Amiodarone, a benzofuran derivative, has been used therapeutically as an antiarrhythmic and coronary vasodilator in Europe since 1964. One of its commoner side effects is cutaneous photosensitivity; more rarely, after ingestion of the drug for around 12 months, a slate-grey or violaceous discoloration of sun-exposed sites may gradually develop. Both of these side effects usually resolve within 2 years of discontinuation of the drug. We now present a woman who developed both photosensitivity and a slate-grey discoloration whilst taking amiodarone; on discontinuation of the drug, the dyspigmentation gradually resolved, but the photosensitivity has persisted and the patient remains symptomatic more than 17 years later.

Photodistribution of Blue-Gray Hyperpigmentation After Amiodarone Treatment

“…7 However, it can sometimes last for several years after drug withdrawal. 10 Amiodarone hyperpigmentation develops mainly in patients with skin type I. It occurs after an average of 20 months of continuous treatment and a minimal cumulative dose of 160 g. 7 The slow rate of elimination of amiodarone and the high uptake by fat-associated tissues may explain the delayed spontaneous disappearance of cutaneous photosensitivity and the late resolution of the blue-gray discoloration.…”

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“…Some reports mention the potential carcinogenic effect of amiodarone, such as the appearance of basal cell carcinoma at sites of previous photosensitivity/phototoxicity. [8][9][10][11] We report a case of a male patient with atrial fibrillation who presented a classic and exuberant reaction of photosensitivity and hyperpigmentation, discussing these findings with what is reported in the literature.…”

Drug-Induced Photosensitivity—From Light and Chemistry to Biological Reactions and Clinical Symptoms

“…Phototoxicity affects 25-75% of patients treated with amiodarone [114]. Clinical manifestations associated with phototoxicity of amiodarone include a burning sensation, erythema, and edema of the face, neck, and hands following a few minutes after sun exposure [115,116]. Skin reactions reported by patients also include a fine maculopapular rash and a slate-grey discoloration of sun-exposed areas.…”

“…Skin reactions reported by patients also include a fine maculopapular rash and a slate-grey discoloration of sun-exposed areas. Blue-grey pigmentation occurs in patients undergoing long-term therapy [ 116 , 117 ]. Amiodarone use is also connected with retinal phototoxicity [ 118 ].…”