Tetracyclines hyperpigmentation

The differential diagnosis for PIH includes the following fixed drug eruption, systemic drug-induced hyperpigmentation, macular amyloid, ashy dermatosis, melasma, and tinea versicolor. Medications such as tetracyclines, antimalarial drugs, arsenic, bleomycin, and doxorubicin can result in hyperpigmentation of the skin. 

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. 

Cheilitis and perioral dermatitis are characteristic of wind players. Flautist s chin consists of hyperpigmentation, papules, and/or pustules on the chin. Systemic tetracyclin therapy has resolved this condition (Dahl 1978). Oboists develop callus on the midportion of the upper lip (Bork 1993), whereas lower-lip dermatitis has been reported among clarinetists (Hindson 1978 Friedman and Connolly 1986). Callus formation occurs on the mid portion of the lips among brass players (Bork 1993) ... 

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