Minocycline hyperpigmentation

Erdmann SM, Poblete P. Hyperpigmentation in a patient under treatment with amiodarone and minocycline. H G Z Hautkr 2001 76 746-8. 

Mouton RW, Jordaan HF, Schneider JW. A new type of minocycline-induced cutaneous hyperpigmentation. Clin Exp Dermatol 2004 29 8-14. 

Minocycline has better gastrointestinal absorption than tetracycline and may be less photosensitizing than either tetracycline or doxycycline. Side effects of minocycline include dizziness and hyperpigmentation of the skin and mucosa, serum-sickness-like reactions, and drug-induced lupus erythematosus. With all the tetracyclines, vaginal candidiasis is a common complication that is readily treated with local administration of antifungal drugs. 

Evidence is very limited but it has been suggested that all patients given long-term minocycline treatment should be well screened for the development of pigmentation, particularly if they are taking other drugs such as the oral contraceptives that are known to induce hyperpigmentation. Remember also that very rarely contraceptive failure has been associated with the use of minocycline and other tetracyclines, see Hormonal contraceptives + Antibacterials Tetracyclines , p.983. 

Ridgeway HA, Sennex TS, Kennedy CTC, Millard PR, Henderson WJ, Gold SC Hyperpigmentation associated with oral minocycline BrJDermatol (1982) 107,95-102... 

After the procedure, the patient is advised to use water-based lotion creams and potent sunscreens. The erythema gradually resolves over about 2-month period. During this time, makeup foundation is encouraged. In dark skin patients (Fitzpatrick skin type 3 or 4), the application of Kligman preparation is recommended to prevent reactive hyperpigmentation. In after-procedural flare-ups, minocycline or systemic isotretinoin are prescribed immediately to avoid new scars creation. 

Two patients treated with minocycline as part of their combination antibiotic regimen for lepromatous leprosy experienced hyperpigmentation thought to be associated with minocycline. In both patients, hyperpigmentation began approximately 1 year after the regimen was started. Biopsies of the lesions in both patients showed inflammatory lesions and histiocytes [10 ]. 

Minocycline was associated with hyperpigmentation in several studies [12, 13, 14, 15 ]. There are various types (I, II and III) of hyperpigmentation based on presentation, biopsy findings and temporal associations with the drug. In some types, the incidence increases with total cumulative dose. 

A 61-year-old man with a past medical history of acne, orthostatic hypotension and Parkinson s disease experienced bluish skin discolouration of his arms, cheeks and nail beds. The patient and his family members reported that the skin discolouration had an insidious onset. The patient had been treated with minocycline 100 mg PO BID for several years. Due to the fact that the patient s presentation and medical history was consistent with Type I hyperpigmentation associated with minocycline, it was thought to be due to long-term minocycline use [16 ]. 

Common medications such as oral contraceptives, hormone replacement, and minocyclines can predispose to postinflammatory hyperpigmentation after a peel. Patients taking these medications should be warned of this possibility and advised on sun avoidance after the peel and regular usage of broad-spectrum sun protection. 

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