Amiodarone Skin Toxicity — EECC MCQ

Correct answer: D — Amiodarone-induced skin photosensitivity and blue-grey discolouration — caused by lipofuscin and amiodarone metabolite (desethylamiodarone) deposition in the skin; patients should be counselled about sun protection with high-SPF sunscreen and protective clothing

Amiodarone causes skin photosensitivity in 25-75% of patients (increased susceptibility to UV-induced sunburn) and blue-grey skin discolouration in ~5-10% with long-term use. Mechanism: (1) photosensitivity: amiodarone absorbs UV light, generating reactive oxygen species causing phototoxic skin damage; (2) blue-grey discolouration: deposition of lipofuscin and the iodinated metabolite desethylamiodarone in the dermis — particularly sun-exposed areas (face, hands). The discolouration is usually irreversible or very slow to resolve after drug cessation (amiodarone's tissue half-life is 40-55 days, and lipofuscin deposits persist). Management: (1) high-SPF broad-spectrum sunscreen; (2) sun-protective clothing; (3) counsel about photosensitivity before starting amiodarone; (4) consider drug cessation if cosmetically unacceptable (balanced against arrhythmia management needs). This is one of many extracardiac toxicities making amiodarone a 'last resort' antiarrhythmic.

Reference: ESC (2024): AF Guidelines; BNF