Treatment of minocycline-induced hyperpigmentation with the Q-switched ruby laser

Tsao, H.

doi:10.1001/archderm.132.10.1250

Cited by 15 publications

(6 citation statements)

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“…The Q-switched ruby, alexandrite, and Nd-Yag lasers have been used successfully for minocycline-induced and amiodarone-induced hyperpigmentation. 2,3,4 We hypothesized that given the clinical similarity to Type I minocycline hyperpigmentation and Fontana-Masson positivity, vandetanib-induced hyperpigmentation might respond similarly. The Q-Switched 755 nm alexandrite laser was selected in this case because of its longer wavelength and greater dermal penetration as compared with ruby or frequency-doubled Q-switched Nd-Yag lasers.…”

Section: Commentmentioning

confidence: 99%

Successful Laser Treatment of Vandetanib-Associated Cutaneous Pigmentation

Brooks¹,

Linehan²,

Srinivasan³

et al. 2011

Arch Dermatol

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Several patterns of cutaneous hyperpigmentation in patients receiving the multikinase inhibitor vandetanib (ZD6474) were recently described. 1 We describe a patient with perifollicular dark blue-gray macular hyperpigmentation secondary to vandetanib who was successfully treated with 755 nm Q-switched alexandrite laser.Report of a Case. A 38 year old patient with Fitzpatrick Type II skin and Von Hippel-Lindau syndrome with associated clear cell renal cell carcinoma enrolled onto a phase 2 study and received once-daily oral vandetanib for treatment of her renal tumors. Within two weeks of initiating treatment, the patient developed an acneiform eruption of scattered erythematous papules and pustules on the face and trunk. After 7 months, the patient also developed multiple perifollicular 1-2 mm slate blue macules on the forehead, cheeks, neck and conchal bowls at sites of existing scars and vandetanib-induced acneiform lesions (Figure 1a). She was treated with doxycycline (100 mg twice daily) and strict photoprotection. Her acneiform lesions improved significantly on doxycycline but recurred when she discontinued therapy.The patient was offered treatment with monthly Q-switched alexandrite laser therapy to address the blue facial pigmentation. A test region on the patient's forehead was treated with the 755 nm Q-switched alexandrite laser using the following settings: 7.5 J/cm2, 3 mm collimated spot size and 50-ns pulse duration with demonstrable lightening of the blue macules. The entire face was treated on subsequent visits with marked improvement (Figure 1b). After four monthly sessions, the treatments were temporarily discontinued, and the blue hyperpigmentation returned. The patient remains on therapy with vandetanib approximately 22 months following enrollment on protocol.

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Section: Commentmentioning

confidence: 99%

Successful Laser Treatment of Vandetanib-Associated Cutaneous Pigmentation

Brooks¹,

Linehan²,

Srinivasan³

et al. 2011

Arch Dermatol

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“…[74] The pigmentation may persist for years even after stopping therapy. Clearance was achieved using quality switched lasers: the Q-switched-Nd:YAG laser, [75] Q-switched ruby laser, [76][77][78] Q-switched-alexandrite laser, [79,80] and fractionated photothermolysis (Fraxel model; Reliant, Mountain View, CA, USA); [81] as well as with oral isotretinoin alone. [82] …”

Section: Pigmentationmentioning

confidence: 99%

Minocycline in Acne Vulgaris

Ochsendorf

2010

American Journal of Clinical Dermatology

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Minocycline is a semi-synthetic, second-generation tetracycline. It was introduced in 1972 and has both antibacterial and anti-inflammatory properties. Minocycline is used for a variety of infectious diseases and in acne. Even today, new indications beyond the antibacterial indications are being investigated such as its use in neurologic diseases. Formerly, minocycline was thought to have a superior efficacy in the treatment of inflammatory acne, especially with respect to antibacterial-resistant Propionibacterium acnes. A thorough review of the literature, however, shows that minocycline is not more effective in acne than other tetracyclines. Compared with first-generation tetracyclines, minocycline has a better pharmacokinetic profile, and compared with doxycycline it is not phototoxic. However, minocycline has an increased risk of severe adverse effects compared with other tetracyclines. It may induce hypersensitivity reactions affecting the liver, lung, kidneys, or multiple organs (Drug Reaction with Eosinophilia and Systemic Symptoms [DRESS] syndrome) in the first weeks of treatment and, with long-term treatment, may cause autoimmune reactions (systemic lupus erythematosus, autoimmune hepatitis). In addition, CNS symptoms, such as dizziness, are more frequent compared with other tetracyclines. Long-term treatment may induce hyperpigmentation of the skin or other organs. Resistance of P. acnes to minocycline also occurs, dependent on the prescribing behavior. Considering the aspects of efficacy, its adverse effect profile, resistance, price, and alternatives, minocycline is no longer considered the first-line antibacterial in the treatment of acne.

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“…Dwyer et al [ Die einzige bislang zur Verfügung stehende Möglichkeit zur Behandlung dieser zwar gutartigen, aber kosmetisch störenden Pigmentierung war das Absetzen des Medikamentes in der Hoffnung, eine langsame, oft über Jahre andauernde Rückbildung der Pigmentierung zu erreichen. Neuere Publikationen berichten über sehr gute Ergebnisse bei der Behandlung von Minozyklin-induzierten Hyperpigmentierungen mit dem gütegeschalteten Rubinlaser (λ-694 nm) [7,17,29]. Während bei dem Patienten mit den Pigmentierungen im Gesicht kein Behandlungswunsch bestand und das Medikament aufgrund der guten Verträglichkeit trotz Pigmentierung nicht abgesetzt wurde, wurde bei dem anderen Patienten eine Probebehandlung mit dem gütegeschalteten Rubinlaser durchgeführt.…”

Section: Elektronenmikroskopieunclassified

Minozyklin-induzierte Hyperpigmentierung

et al. 1998

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A common adverse effect of minocycline therapy is cutaneous pigmentation. We describe two patients who presented with hyperpigmentation caused by minocycline. One patient, aged 54 years, had taken minocycline due to lung silicosis for 3 years before black pigmentation of the face occurred. The other 49 year-old patient developed grey-black hyperpigmentation on both lower legs after a 6-month therapy with minocycline for folliculitis. This patient was treated with the Q-switched ruby laser and the pigmentation resolved in the treated area. The different clinical and histological forms of minocycline-induced hyperpigmentation are discussed.

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Treatment of minocycline-induced hyperpigmentation with the Q-switched ruby laser

Cited by 15 publications

References 0 publications

Successful Laser Treatment of Vandetanib-Associated Cutaneous Pigmentation

Successful Laser Treatment of Vandetanib-Associated Cutaneous Pigmentation

Minocycline in Acne Vulgaris

Minozyklin-induzierte Hyperpigmentierung

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