![]() Minocycline was withdrawn, and after 5 years only subtle hyperpigmentation remained on her legs.Īccording to the authors, this was the first case of minocycline-induced pigmentation with pigment exclusively localized to subcutaneous fat.įixed drug eruptions are characterized by solitary or multiple, round or oval, erythematous patches of variable size some of them develop into bullae or superficial erosions. A Perls stain for iron was negative and a Von Kossa stain was negative for calcium. A Fontana-Masson stain showed that the pigment was melanin or a melanin-like substance. A punch biopsy showed normal epidermis and dermis, but deep in the subcutaneous fat there were macrophages and multinuclear giant cells containing brown-greenish pigment in their cytoplasm. She had taken minocycline twice daily for acne vulgaris for more than 1 year. There was a faint bluish discoloration under the tongue, on the alveolar surface of the gums, and on the hard palate. The lesions were not painful but were vaguely sensitive to pressure and touch. Ī 15-year-old girl with no significant past medical history developed bilateral leg discoloration.Minocycline-induced hyperpigmentation can even take place in scars and, more rarely, in subcutaneous fat. Two patients developed minocycline-induced pigmentation of the soft tissue of the palate, confirmed by biopsy. The patients were followed for 3 years and their pigmentation did not change. Energy-dispersive X-ray analysis confirmed the presence of calcium. Electron microscopy showed electron-dense granules, both free and membrane bound, within macrophages and some other cells in the dermis. Histochemistry identified a calcium-containing melanin-like substance. Histology showed pigment within dendritic cells and extracellularly throughout the dermis. Both had blue-grey pigmentation confined to acne scars on the back, whereas scars on the face and chest were unaffected, and there was no hyperpigmentation in other areas. The second took minocycline in two different periods before presentation, estimated dose 13.5 g. The first took minocycline 100 mg/day for 1 month, estimated cumulative dose 3 g, 2 years before presentation). Two 22-year-old men with acne were given minocycline. Type III is diffuse muddy brown pigmentation of normal skin accentuated in sun-exposed areas. Type II is blue-grey circumscribed pigmentation of normal skin of the lower legs and forearms. Type I is blue-black pigmentation confined to sites of scarring or inflammation on the face. According to a well-accepted classification there are three distinct clinical pictures. The incidence of skin discoloration from minocycline varies from 2.4% to almost 15%.
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