Imipramine‐induced hyperpigmentation: a case report and review of the literature

Abstract

Imipramine-induced hyperpigmentation is rare with only 13 cases reported in the literature to date. We report a 64-year-old female who presented with blue-gray discoloration on her face present for 4-5 years. The patient's medications included imipramine for depression for approximately 23 years. Physical examination revealed slate-gray hyperpigmented discrete and coalescing macules of the malar cheeks and the bilateral temples and periorbitally. She also had diffuse gray pigmentation of the bilateral dorsal hands. Histologic examination revealed an unremarkable epidermis with golden-brown round globules clustered in the superficial dermis, which stained strongly positive with a Fontana-Masson stain. Prussian blue stain for hemosiderin was negative. A diagnosis of imipramine-induced hyperpigmentation was made. Imipramine-induced hyperpigmentation as well as a detailed review of drug-induced hyperpigmentation is discussed.

The diagnosis and treatment of myotonic disorders

“…In a randomized, double‐blind, crossover study, imipramine improved timed grip and percussion myotonia compared with placebo in a population of 12 DM1 patients . Although relatively well tolerated, imipramine at therapeutic doses can cause hyperpigmentation, arrhythmias, tachycardia, hypotension, or sedation …”

Melasma: A rare adverse effect of clomipramine

“…[ 8 ] There are few case reports of such pigmentation with the use of imipramine, a congener of clomipramine. [ 9 ] This is probably the second case study, reporting the rare side effect of clomipramine. Clinicians must be aware of probable hyperpigmented cutaneous ADRs like melasma with clomipramine.…”

Drug-Induced Hyperpigmentation: Review and Case Series

“…This adverse effect has been reported especially with imipramine. 37 There are also reported cases of hyperpigmentation associated with amitriptyline. 9 There are cases of hyperpigmentation caused by olanzapine, an atypical antipsychotic used both for schizophrenia and for depressive episodes associated with bipolar disorder, although cutaneous reactions are very rare.…”