Hyperpigmentation Effects of Some Medications and Heavy Metals
Substance | Effect |
|---|---|
Medications | |
Amiodarone | Slate-gray to violaceous discoloration of sun-exposed areas; yellowish brown deposits in the dermis |
Antimalarials | Yellow-brown to gray to bluish black discoloration of pretibial areas, face, oral cavity, and nails; medication–melanin complexes in the dermis; hemosiderin around capillaries |
Bleomycin | Flagellate hyperpigmented streaks on the back, often in areas of scratching or minor trauma |
Cancer chemotherapy agents, including busulfan, cyclophosphamide, dactinomycin, daunorubicin, and 5-fluorouracil (5-FU) | Diffuse hyperpigmentation |
Desipramine Imipramine | Grayish blue discoloration on sun-exposed areas; golden-brown granules in upper dermis |
Hydroquinone | Bluish black discoloration of ear cartilage and face after years of use ("rebound hyperpigmentation") |
Phenothiazines, including chlorpromazine | Grayish blue discoloration on sun-exposed areas; golden-brown granules in upper dermis |
Tetracyclines, particularly minocycline | Grayish discoloration of teeth, nails, sclerae, oral mucosa, acne scars, face, forearms, and lower legs |
Heavy metals | |
Arsenic | Can manifest with hyperpigmentation or hypopigmentation in a raindrop-like pattern ("raindrop" hypopigmentation) White transverse lines of the fingernails (Mees lines [leukonychia striata]) |
Bismuth | Blue-gray discoloration of face, neck, and hands |
Gold | Blue-gray deposits around the eyes (chrysiasis) |
Mercury | Slate-gray discoloration of skinfolds |
Silver | Diffuse slate-gray discoloration (argyria), especially in sun-exposed areas |