Minocycline-related hyperpigmentation.
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Skin biopsy specimens and discolored fingernails from minocycline-treated patients were examined by light and electron microscopy, histochemistry, and energy-dispersive x-ray analysis. Both hyperpigmented and adjacent normally pigmented skin samples contained pigment-laden macrophages in the dermis, although these cells were more numerous in the hyperpigmented skin samples. Elemental analysis showed that both pigment deposits and stratum corneum of hyperpigmented skin samples contained iron and calcium. Discolored areas of fingernails from a minocycline-treated patient also contained iron and calcium. Both skin and nail discoloration were possibly due to the presence of an iron chelate of minocycline and/or quinoid derivatives of minocycline. The presence of iron-containing pigment in normal as well as hyperpigmented skin may have predisposed to formation of minocycline-associated pigment in these patients.
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A previously healthy 62 years old man was admitted for weight loss, weakness and pigmentation of skin with increased tumor markers and altered hepatic tests. The final diagnosis was Systemic Lupus Erythematosus, despite clinical appearance. High doses of glucocorticoids were used and a sudden improving of the disease was obtained.
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Five patients are reported in whom brownish grey discoloration occurred on the light-exposed parts of the dermis after long-term amiodarone-medication. Histological investigation shows that the deposition of lipofuscin in the small veins and perivasal superior part of the corium is responsible for the occurrence of this discoloration. With reference to recent data in the literature, the pathomechanism and prevention of this pigmentation are discussed.
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