Drug induced pigmentation

Background

Drug-induced pigmentation of the skin may occur as a consequence of drug administration, and the mechanism may be postinflammatory hyperpigmentation in some cases, but frequently is related to actual deposition of the offending drug in the skin.The incidence of this change varies and depends on the type of medication involved. Some of the most common drugs involved are NSAIDs, Antimalarials, psychotropic drugs, Amiodarone, cytotoxic drugs, tetracyclines and heavy metals such as silver and gold (must be ingested not just worn).

Pathophysiology

There are 4 possible mechanisms to how this change may occur:

1. Accumulation of melanin, the skin pigment
2. Accumulation of drug or one of its products under any layer of the skin (usually the dermis or epidermis)
3. Accumulation of iron throughout the dermis from drug-induced post-inflammatory changes
4. The synthesis of special pigments, under direct influence of the drug