Minocycline, a tetracycline derivative antibiotic, is widely employed to manage acne, rosacea and other inflammatory skin diseases. However, consuming minocycline may induce skin pigmentation, and if it is not treated, it may take months to years for the symptoms to diminish after discontinuation of the drug, or it may never disappear completely, which can cause cosmetic anxiety and affect the quality of life. Available treatment options for hyperpigmentation utilized mainly Q-switched Nd:YAG, ruby and alexandrite lasers. The present article reports using an amalgamation of chemical peel and intense pulsed light in a female patient with eosinophilic cellulitis (Wells syndrome) on oral minocycline. 

Twenty-nine years old female, who was diagnosed with Wells syndrome a year ago and was taking minocycline capsules orally for treating primary skin disease 1 month before the appearance of hyperpigmentation on the face. The hyperpigmentation was thought to be minocycline-induced based on the time node of the occurrence and the inherent adverse effects of oral minocycline, including the formation of hyperpigmentation. So, she was advised to stop the medication and avoid light. She received treatment of chemical peel using 4 mL of glycolic acid at 35% concentration, with the duration of action as 5, 7 and 10 minutes for the first and third times. The endpoint reaction of each therapy was mild skin erythema; however, her pigmentation faded gradually after three consecutive chemical peels (35% concentration of fruit acids). Boosting the treatment concentration of fruit acids alone to further fade the pigmentation would have caused serious adverse reactions. Thus, the dermatologists changed the therapy to intense pulsed light once a month for three consecutive times, with the wavelength as 560, and the doses before and after three times as 15 MJ, 14 MJ and 16 MJ, respectively. The endpoint response was a mild deepening of the hyperpigmented area. Chemical peeling and intense pulsed light combination largely subsided the patients facial hyperpigmentation.

This case indicates that chemical peel and intense pulsed light combination are effective treatments for minocycline-induced hyperpigmentation.

Source: Li Y, Zhen X, Yao X, Lu J. Successful treatment of minocycline-induced facial hyperpigmentation with a combination of chemical peels and intense pulsed light. Clin Cosmet Investig Dermatol. 2023;16:253-6.