Drug-Induced Hyperpigmentation: Review and Case Series

García, Rosa María Giménez; Carrasco-Molina, Sergio

doi:10.3122/jabfm.2019.04.180212

Cited by 48 publications

(44 citation statements)

References 66 publications

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“…Medication‐induced hyperpigmentation is a common dermatologic complaint that not only adversely affects the patient's appearance but also quality of life. Skin darkening can occur via several different mechanisms, including hypermelanosis, hyperchromia, and deposition of exogenous materials in the dermis (ie, iron, metals, hemosiderin) 4 . Hypermelanosis in the epidermis is associated with increased melanin in the basal or suprabasal layers with either a normal or increased number of melanocytes.…”

Section: Discussionmentioning

confidence: 99%

Polymyxin B‐induced skin hyperpigmentation

Milikowski

Selvaggi

et al. 2020

Transplant Infectious Dis

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Polymyxin B-induced skin hyperpigmentation is a rare adverse drug reaction (ADR). In this report, we present the case of a patient who underwent an abscess resection with right epididymitis, in which a multidrug-resistant Klebsiella pneumoniae infection (KPI) is formed. e patient was treated with polymyxin B and subsequently developed skin hyperpigmentation and desquamation. e desquamation improved and the pigmentation gradually returned to normal after sixty days after the withdrawal of polymyxin B.

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Section: Discussionmentioning

confidence: 99%

Polymyxin B‐induced skin hyperpigmentation

Milikowski

Selvaggi

et al. 2020

Transplant Infectious Dis

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“…A small but significant fraction (10% to 20%) of acquired pigmentation cases are drug-induced [ 6 ]. Minocycline is the most common antibiotic responsible for drug-induced hyperpigmentation [ 6 , 7 ]. In a few isolated cases, polymyxin and tigecycline have caused this condition [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Minocycline is the most common antibiotic responsible for drug-induced hyperpigmentation [ 6 , 7 ]. In a few isolated cases, polymyxin and tigecycline have caused this condition [ 7 ]. Among the quinolones, few cases have been reported, and all were due to pefloxacin and levofloxacin.…”

Section: Discussionmentioning

confidence: 99%

Levofloxacin-Induced Acute Hyperpigmentation Changes in a Chronic Kidney Disease Patient

Patil

Campbell

et al. 2020

Case Reports in Medicine

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Medication-induced cutaneous hyperpigmentation has variable clinical presentations and is dependent on the specific drug involved. Most commonly, an attentive patient observes such changes early in the course; when missed by the patient, such changes are usually noted by an observant clinician. Clinical diagnosis can be challenging if the patient is on multiple medications because other causes must be excluded. This condition occurs via multiple mechanisms. Frequently, the pigmentary change is reversible with discontinuation of the drug. Causative medications include nonsteroidal; anti-inflammatory agents, antimalarials, antibiotics, psychotropics, amiodarone, and chemotherapeutic agents. The; antimicrobials responsible for hyperpigmentation are antimalarials, tetracyclines, tigecycline, dapsone, rifampicin, and antiretrovirals such as zidovudine. Sunlight exposure can worsen the pigmentation seen with some of the above antimicrobials (e.g., dapsone). Here, we describe an older adult white woman presenting with acute cutaneous; hyperpigmentation of the bilateral lower extremities while on levofloxacin therapy. Hyperpigmentation resolved after cessation of the agent. Our case highlights this unique acute presentation after only a few days of oral levofloxacin.

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“…Acquired skin hyperpigmentation is a common dermatologic complaint, which is attributable to drugs up to 20% of all cases ( Nahhas et al., 2019 ). Many drugs are associated with skin hyperpigmentation such as nonsteroidal anti-inflammatory agents, antihypertensive agents, antibiotics, and psychoactive agents ( Giménez García and Carrasco Molina, 2018 ). Nephrotoxicity and neurotoxicity are common adverse reactions of polymyxin B, while skin hyperpigmentation was also reported as a side effect recently ( Li et al., 2020 ).…”

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confidence: 99%

Skin Hyperpigmentation in Coronavirus Disease 2019 Patients: Is Polymyxin B the Culprit?

Hou

2020

Front. Pharmacol.

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From mid-December 2019, the outbreak of the coronavirus disease 2019 (COVID-19) in Wuhan has spread worldwide and become an emergency of major international concerns (Pascarella et al., 2020). Recently, a television report has drawn extensive attention of the public in China. Two frontline doctors of the central hospital of Wuhan, Fan Yi and Weifeng Hu, were unfortunately infected by COVID-19. Cutaneous hyperpigmentation of the two doctors was noticed in the TV interview. Many people expressed grave concerns about the pathogenesis and prognosis of their skin pigmentary disorder. Fan Yi and Weifeng Hu were diagnosed with COVID-19 infection on January 18 and January 28, respectively. The illness progress of the two doctors was very rapid and they were transferred to the intensive care unit for further treatment. Extracorporeal membrane oxygenation (ECMO) was provided as rescue therapy for respiratory failure. Because of prolonged hospital stay, mechanical ventilation, and presence of invasive devices, some critically ill patients suffered from infections caused by multidrug-resistant (MDR) bacteria (Bassetti et al., 2018). Polymyxin B was used in these two doctors for the treatment of MDR infections. Polymyxin B is a cyclic polypeptide antibiotic that regained significant interest due to the inevitable appearance of MDR bacteria (Rigatto et al., 2019). It is even being considered as last resort therapy against some intractable gram-negative bacteria (Manchandani et al., 2018). Acquired skin hyperpigmentation is a common dermatologic complaint, which is attributable to drugs up to 20% of all cases (Nahhas et al., 2019). Many drugs are associated with skin hyperpigmentation such as nonsteroidal anti-inflammatory agents, antihypertensive agents, antibiotics, and psychoactive agents (Gimeńez Garcıá and Carrasco Molina, 2018). Nephrotoxicity and neurotoxicity are common adverse reactions of polymyxin B, while skin hyperpigmentation was also reported as a side effect recently (Li et al., 2020). Reports of polymyxin B associated skin hyperpigmentation in adults were rare, unlike in neonates (Zavascki et al., 2015; Gothwal et al., 2016). Polymyxin B is mainly excreted through the kidney, dosage adjustment is required in patients with lower creatinine clearance (Zheng et al., 2018). The cumulation of polymyxin B might be a possible reason for skin hyperpigmentation in neonates due to their immature kidney function (Gothwal et al., 2016; Li et al., 2020). Kidney involvement is prevalent in patients with COVID-19. Acute kidney injury (AKI) has been reported in approximately 20%-40% of critically ill or deceased COVID-19 patients (Ronco et al., 2020). Several mechanisms are possibly involved in COVID-19 associated AKI, including direct damage action of the virus, hemodynamic alterations, inflammatory cytokines, administration of nephrotoxic drugs, and mechanical ventilation (Gabarre et al., 2020; Martinez-Rojas et al., 2020). According to these findings, we speculate that AKI may be an important factor

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Drug-Induced Hyperpigmentation: Review and Case Series

Cited by 48 publications

References 66 publications

Polymyxin B‐induced skin hyperpigmentation

Polymyxin B‐induced skin hyperpigmentation

Levofloxacin-Induced Acute Hyperpigmentation Changes in a Chronic Kidney Disease Patient

Skin Hyperpigmentation in Coronavirus Disease 2019 Patients: Is Polymyxin B the Culprit?

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