Skin pigmentation chlorpromazine

A variety of relatively uncommon dermatological side effects have been noted to be associated with antipsychotic agents. These include maculopapular rashes, urticaria, and erythema multiforme (Arana, 2000). Photosensitivity and skin pigmentation can also occur during treatment with these drugs. Although skin pigmentation has been most frequently reported with chlorpromazine, this can occur with thioridazine and trifluoperazine (Harth and Rapoport, 1996). In addition, treatment-induced alopecia has been reported for haloperidol, olanzapine, and risperidone (Mercke et ah, 2000). 

A 45-year-old schizophrenic woman with blue eyes and blond hair who had received a lifetime exposure of at least 1748 g of chlorpromazine had blue discoloration of the skin by age 36 (523). Chlorpromazine was withdrawn and clozapine substituted (up to a maximum of 600 mg/day). The skin pigmentation resolved over 4 years. 

Melanosis manifested by skin pigmentation, ocular opacities, and pigmented retinopathy have been reported as side effects of long-term therapy. These observations make the potential interaction of chlorpromazine with melanin of practical and clinical significance. 

A. C. Greiner and K. Berry, Skin Pigmentation and Corneal and Lens Opacities with Prolonged Chlorpromazine Therapy, Can. Med. Ass. J. 90, 363-365 (1964). 

Serious side-effects have been associated with the important psychotherapeutic agent, chlorpromazine (358), almost since its introduction. High sensitivity to sunburn, pigmentation of the skin and ocular opacity are common phototoxic effects [ 196]. In a series of phenothiazines, the chloro-substituted compounds, particularly chlorpromazine, prochlorperazine and perphenazine, showed by far the greatest phototoxic activity [197, 198]. 

Reduced bile output can result in an accumulation of bilirubin, a dark-colored pigment produced by the breakdown of blood heme. When this product is not discharged at a sufficient rate with bile, it accumulates in skin and eyes, giving the characteristic sickly color of jaundice. Impaired production and excretion of bile is known as canalicular choleostasis. It can be caused by a number of xenobiotic substances, such as chlorpromazine. Reduced bile output can also result from damage to bile ducts. Methylene dianiline used in epoxy resins is known to harm bile ducts. 

Blue-gray or purplish skin coloration in areas exposed to sunlight occurs in patients receiving higher doses of low-potency phe-nothiazines during long-term administration, especially with chlorpromazine. It commonly occurs with concurrent comeal or lens pigmentation. 

Ban TA, Lehmann HE, Gallai Z, Wames H, Lee H (1965) Relation Between Photosensitivity and the Pathological Pigmentation of the Skin Produced by High Doses of Chlorpromazine. Union Med Canada 94 305... 

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