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Minocycline-associated Blue Skin, Nail and Scleral Pigmentation

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    25 November 2022

A report describes a case of an 83-year-old man who presented with long-standing hyperpigmentation of the skin, oral mucosa, sclera and nails. He documented a history of squamous cell carcinoma, atrial fibrillation, essential hypertension, benign prostatic hyperplasia and consumption of medications like apixaban, hydrochlorothiazide and tamsulosin. Before the presentation, he reported consuming minocycline 100 mg daily for more than 50 years for acne vulgaris (self-prescribed).

 

Physical examination revealed gray-blue patches involving the shins and face, with diffuse gray-blue discoloration of the sclera, gums and all fingernails. His visual function was intact. 

 

After excluding all other causes, he received a clinical diagnosis of minocycline-induced pigmentation.

 

Thus, it is crucial to inform patients receiving treatment with minocycline about this possible side effect, especially those receiving long-term treatment with cumulative doses >100 g. Pigmentation patterns type I and II, as well as nail pigmentation, may persist for prolonged periods and resolve with drug cessation, while type III pigmentation is often permanent. These can be treated successfully with Q-switched lasers.

 

Source: Ricardo JW, Shah K, Minkis K, et al. Blue skin, nail, and scleral pigmentation associated with minocycline. Case Rep Dermatol. 2022;14(2):239-42.

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