Drug-induced pigmentation or dyspigmentation represents 10%-20% of all cases of acquired hyperpigmentation. Mechanisms of drug-induced pigmentation include cutaneous deposition of the drug or its metabolites, accumulation of melanin, deposition of iron, or synthesis and deposition of special pigments such as lipofuscin. Increased melanin produces brown pigmentation. When medications are deposited in the dermis, they can cause blue-black or muddy brown macules. Drugs commonly associated with hyperpigmentation include NSAIDs, antimalarials, psychotropic medications, amiodarone, bleomycin, tetracyclines (most commonly minocycline), chemotherapeutic agents, and metals such as silver and gold.

Minocycline-induced pigmentation is of special note as it has been among the most widely used of these medications in adolescents, as a primary antibiotic choice in the treatment of moderate to severe acne vulgaris. Usually, the pigmentation develops after a year or more of therapy, but it has been reported to occur after just a few weeks to a couple of months.

Related topics: drug-induced flagellate pigmentation, amiodarone drug-induced pigmentation, drug-induced hypopigmentation, drug-induced oral pigmentation, drug-induced nail pigment, fixed drug eruption