Drug-Induced Pigmentary Changes
Exposure to a variety of pharmacologic agents can result in pigmentary changes involving the skin, nails, hair, and mucous membranes. Although typically benign, the hyperpigmentation, hypopigmentation, or dyspigmentation that results can have a profound p
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Drug-Induced Pigmentary Changes Lauren A. Baker and Amit G. Pandya
Contents
8.1
8.1 8.1.1 8.1.2
Introduction...................................................................... Epidemiology..................................................................... Etiology..............................................................................
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8.2 8.2.1
Clinical Features .............................................................. Distribution and Arrangement ...........................................
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8.3
Natural History and Prognosis .......................................
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8.4
Histopathological Features..............................................
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8.5
Diagnosis and Differential Diagnosis .............................
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8.6
Treatment .........................................................................
43
References .....................................................................................
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Introduction
Exposure to a variety of pharmacologic agents can result in pigmentary changes involving the skin, nails, hair, and mucous membranes. Although typically benign, the hyperpigmentation, hypopigmentation, or dyspigmentation that results can have a profound psychological impact on those affected, particularly in individuals with darker skin [1].
8.1.1
Epidemiology
The incidence of drug-induced pigmentation is dependent on the inciting agent. It is estimated that medications account for 10–20 % of all cases of acquired hyperpigmentation. While these changes may occur in individuals of any ethnic background, hypomelanosis and hyperpigmentation are seen more commonly in those with darker skin [1]. There are no reported differences in the prevalence of drug-induced dyschromia between males and females, and it occurs in persons of all ages.
8.1.2
Etiology
The main causes of drug-induced dyschromia are cytotoxic drugs, antimalarials, amiodarone, tetracyclines, psychotropic drugs, nonsteroidal anti-inflammatory drugs, and heavy metals [2].
L.A. Baker, BS • A.G. Pandya, MD (*) Department of Dermatology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA e-mail: [email protected]; [email protected] D. Jackson-Richards, A.G. Pandya (eds.), Dermatology Atlas for Skin of Color, DOI 10.1007/978-3-642-54446-0_8, © Springer-Verlag Berlin Heidelberg (outside the USA) 2014
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L.A. Baker and A.G. Pandya
Several mechanisms are responsible for the pathogenesis of drug-induced pigmentation, and these vary depending on the offending agent. Often, the cause of drug-induced dyschromia is the accumulation of melanin after nonspecific cutaneous inflammation, with or without an accompanying increase in melanocytes. Other mechanisms include drug or drug metabolite deposition in the epidermis and dermis, drug-induced synthesis of special pigments, and iron deposits following damage to vessels in the dermis [2]. Sun exposure is often an exacerbating factor in drug-induced pigmentation via the
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