Drug-Induced Pigmentation — SCE Dermatology MCQ

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ModerateDrug ReactionsDrug-Induced PigmentationSCE Dermatology

A 65-year-old woman develops drug-induced pigmentation. She has been on Amiodarone for 5 years and has slate-grey discolouration of sun-exposed skin, particularly the face. What is the mechanism of Amiodarone-induced pigmentation?

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Correct answer: E — Deposition of lipofuscin-like material and drug-iodine complexes in the dermis enhanced by UV exposure

Amiodarone-induced skin pigmentation (present in approximately 10% of patients on long-term therapy) results from deposition of lipofuscin-like material and drug-iodine complexes in the dermis, enhanced by UV exposure. The slate-grey/blue-grey colour affects photo-exposed areas. Other drugs causing pigmentation include Minocycline (blue-grey, multiple mechanisms including melanin-iron chelation), Chloroquine/Hydroxychloroquine (brown-grey), and Bleomycin (flagellate hyperpigmentation). The pigmentation is slowly reversible (months to years) after drug cessation. Sun protection during treatment may reduce pigmentation risk.

Reference: BAD 2019; BNF Amiodarone side effects; Drug-Induced Pigmentation Review