Background: Hyperpigmentation is a common dermatologic problem that may have substantial impact on the patient, since it affects the appearance and quality of life, and may influence treatment adherence. There are few studies of drug-induced hyperpigmentation. Methods: We studied drug-induced hyperpigmentation in patients attending an outpatient dermatology clinic in the Western Area of Valladolid (Spain) from August 1, 2017 to April 20, 2018. Results: The incidence of drug-induced hyperpigmentation was 1.31% in patients attending a first dermatology consultation in the study period. Of the 16 patients, 8 were taking more than 1 drug. The most frequent drugs identified were nonsteroidal anti-inflammatory agents (25%), antihypertensive agents (18.75%), antimalarials (12.5%), antibiotics, antineoplastic agents, psychoactive agents, simvastatin, allopurinol, amiodarone and mucolytic (6.25% each). Hyperpigmentation was found in the mucosa in 25% of patients and in photograph-exposed areas in 37.5%. Discussion: Diagnosing drug-induced hyperpigmentation is a dermatologic challenge. A differential diagnosis with hyperpigmentation caused by endocrine and metabolic disorders, the most closely-related disorders to drug-induced hyperpigmentation, and with hyperpigmentation of idiopathic origin, should be conducted. Drug-induced hyperpigmentation is a relatively frequent reason for consultation, especially in polypharmacy patients. The sample may have been biased as many patients receiving treatments frequently associated with drug-induced hyperpigmentation, such as antineoplastic drugs, are diagnosed and treated by other specialties, such as oncologists. Conclusion: Family physicians and specialists should consider drugs as a cause of hyperpigmentation to facilitate the correct diagnosis and treatment.

Background Antibiotics used to treat livestock species enter agricultural fields when they are excreted by grazing animals or are present in manure that is added to fields as fertiliser. In the European Union, the potential effects of such antibiotics on terrestrial plants must be evaluated following the standardised OECD 208 method, which specifies the crop and wild species that should serve as “sentinels” for assessing antibiotic exposure. The present study aimed to compare this approved list of sentinel species against crop and wild plant species actually present in agricultural and pasture lands in Mediterranean Europe in order to identify the most appropriate sentinel plants for the region. The study focused on Spain as a region representative of Mediterranean Europe. Georeferenced layers for wild plant species and cultivated areas (crops), livestock density and land cover were combined, and then selection criteria were applied, leading to the identification of sentinel crop species for agriculture and pasture scenarios. Results In the agriculture scenario, the sentinel crop species were barley, wheat, corn, sunflower, dried pie, alfalfa, vetch, oilseed rape and sugar beet; the sentinel wild species were Papaver rhoeas, Galium aparine and Chenopodium album. In the pasture scenario, sentinel wild species were Bromus tectorum, Agrostis capillaris, Trifolium pratense, Lotus corniculatus and Galium aparine. The following common weed species in field boundaries or in pasture lands also emerged as potential sentinel species for risk assessment, even though they are not listed in the OECD 208 method: Sonchus oleraceus, Avena sterilis, Dactylis glomerata, Hordeun murinum and Lolium rigidum. Conclusions The sentinel species identified in this study may be useful in risk assessment procedures covering Mediterranean Europe. The method developed for this study could be useful for identifying sentinel species for other geographical areas.

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