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Minocycline-Induced Hyperpigmentation

  • Leonid Skorin and Stephanie Norberg
Published/Copyright: July 1, 2018
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Journal of Osteopathic Medicine
From the journal Journal of Osteopathic Medicine Volume 118 Issue 7

Keywords: conjunctival pigmentation; hyperpigmentation; minocycline

A 55-year-old woman presented with bilateral asymptomatic bluish lesions on the inferior tarsal conjunctiva (image A, arrows). Her medication included 100 mg of minocycline daily for the past 4 years to manage acne and rosacea. Cutaneous examination revealed subtle bluish hyperpigmentations on her face and left prepatellar region (image B, arrows). To prevent further hyperpigmentation, minocycline was discontinued.

Minocycline is the most lipophilic of the tetracycline agents, and this characteristic is responsible for its excellent tissue penetration. Minocycline-induced hyperpigmentation can affect the skin, nails, teeth, oral mucosa, bones, thyroid gland, conjunctiva, and sclera.1,2 Conjunctival pigmentation from minocycline is typically seen within palpebral conjunctival inclusion cysts.3 Early recognition of minocycline-induced hyperpigmentation is important to prevent permanent cutaneous discoloration.1 Potential risk factors for hyperpigmentation include a history of vitamin D deficiency, noncirrhotic liver disease, and concurrent use of other medications that can cause hyperpigmentation.4 Cutaneous hyperpigmentation may fade years after minocycline cessation, but ocular and internal visceral hyperpigmentation is typically permanent.1,2

From the Mayo Clinic Health System in Albert Lea, Minnesota (Dr Skorin), and the Pacific University College of Optometry in Forest Grove, Oregon (Ms Norberg). Dr Norberg is a recent graduate of the Pacific University College of Optometry.
Financial Disclosures: None reported.
Support: None reported.

*Address correspondence to Leonid Skorin Jr, DO, OD, MS, Mayo Clinic Health System, 404 W Fountain St, Albert Lea, MN 56007-2437. Email:

References

1. Khan TT , ReddyUP. Conjunctival pigmentation following minocycline therapy. Ophthal Plast Reconstr Surg. 2014;32(6):e129-e130. doi:10.1097/IOP.0000000000000315Search in Google Scholar PubMed

2. Matsuura H , SenooA, HamanakaY.Minocycline-induced hyperpigmentation.QJM.2017;110(5):323. doi:10.1093/qjmed/hcx051Search in Google Scholar PubMed

3. Skorin L Jr , TurpinS. Minocycline-induced hyperpigmentation of the skin, sclera, and palpebral conjunctiva. Can J Ophthalmol. 2017;52(2):e79-e81. doi:10.1016/j.jcjo.2016.09.005Search in Google Scholar PubMed

4. Hanada Y , BerbariEF, SteckelbergJM. Minocycline-induced cutaneous hyperpigmentation in an orthopedic patient population.Open Forum Infect Dis.2016;3(1): ofv107. doi:10.1093/ofid/ofv107Search in Google Scholar PubMed PubMed Central

Received: 2017-10-02
Accepted: 2018-10-10
Published Online: 2018-07-01
Published in Print: 2018-07-01

© 2018 American Osteopathic Association

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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https://doi.org/10.7556/jaoa.2018.114
Keywords for this article
conjunctival pigmentation; hyperpigmentation; minocycline
Creative Commons
BY-NC-ND 4.0

Articles in the same Issue

  1. LETTERS TO THE EDITOR
  2. Response
  3. OMT MINUTE
  4. Osteopathic Lymphatic Pump Techniques
  5. STILL RELEVANT?
  6. The Rule of the Artery Is Supreme. Or, Is It?
  7. LETTERS TO THE EDITOR
  8. Progressive Infantile Scoliosis Managed With Osteopathic Manipulative Treatment
  9. AOA COMMUNICATION (REPRINT)
  10. Official Call: 2018 Annual Business Meeting of the American Osteopathic Association
  11. Proposed Amendments to the AOA Constitution, Bylaws, and Code of Ethics
  12. ORIGINAL CONTRIBUTION
  13. Medical Students’ Knowledge, Attitudes, and Behaviors With Regard to Skin Cancer and Sun-Protective Behaviors
  14. Lymphatic Pump Treatment Mobilizes Bioactive Lymph That Suppresses Macrophage Activity In Vitro
  15. JAOA/AACOM MEDICAL EDUCATION
  16. Oral Health Training in Osteopathic Medical Schools: Results of a National Survey
  17. CASE REPORT
  18. Perplexing Rash: Challenges to Diagnosis and Management of Mycosis Fungoides
  19. Laparoscopic Adjustable Gastric Band Erosion Into the Stomach and Colon
  20. THE SOMATIC CONNECTION
  21. Safety of Chiropractic Manipulation in Patients With Migraines
  22. Effect of HVLA on Chronic Neck Pain and Dysfunction
  23. Effects of Adding Cervicothoracic Treatments to Shoulder Mobilization in Subacromial Impingement Syndrome
  24. Manipulation Under Anesthesia Thaws Frozen Shoulder
  25. Treating Patients With Low Back Pain: Evidence vs Practice
  26. Reducing Low Back and Posterior Pelvic Pain During and After Pregnancy Using OMT
  27. Neuromuscular Manipulation Improves Pain Intensity and Duration in Primary Dysmenorrhea
  28. Reducing Cesarean Delivery Rates and Length of Labor by Addressing Pelvic Shape
  29. Remote MFR Increases Hamstring Flexibility: Support for the Fascial Train Theory
  30. CLINICAL IMAGES
  31. Minocycline-Induced Hyperpigmentation
  32. Massively Enlarged Leiomyomatous Uterus
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