Photodistribution of blue-gray hyperpigmentation after amiodarone treatment: molecular characterization of amiodarone in the skin.
BACKGROUND
For decades, the photodistributed blue-gray skin hyperpigmentation observed after amiodarone therapy was presumably attributed to dermal lipofuscinosis. Using electron microscopy and high-performance liquid chromatography, we identified amiodarone deposits in the hyperpigmented skin sample from a patient treated with this antiarrhythmic agent. Our findings therefore indicate that the hypothesis relating the blue-gray hyperpigmentation to lipofuscin should be challenged.


METHODS
A 64-year-old man, skin phototype III, presented with asymptomatic skin hyperpigmentation that had been slowly developing on sun-exposed areas since April 2004. He had been taking amiodarone for 4 years (cumulative dose, 277 g). Electron microscopy did not show lipofuscin pigments in his skin. Conversely, abundant electron-dense membrane-bound granule deposits were observed in most of the dermal cells (fibroblasts, macrophages, pericytes, Schwann cells, and endothelial cells), especially in photoexposed skin. High-performance liquid chromatography confirmed that the skin deposits were composed of amiodarone. These results demonstrate that amiodarone hyperpigmentation is related to drug deposition on photoexposed skin.


CONCLUSIONS
Amiodarone-related hyperpigmentation should be considered a skin storage disease that is secondary to drug deposition.
Ammoury
Alfred
A
Service de Dermatologie, Centre Hospitalier Universitaire de Toulouse, Hôpital Purpan, 31059 Toulouse CEDEX, France. docalf@yahoo.com
Michaud
Sandra
S
Paul
Carle
C
Prost-Squarcioni
Catherine
C
Alvarez
Florence
F
Lamant
Laurence
L
Launay
François
F
Bazex
Jacques
J
Chouini-Lalanne
Nadia
N
Marguery
Marie-Claude
MC
D000638:Amiodarone / Q000009:adverse effects* / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001707:Biopsy, Needle; D002851:Chromatography, High Pressure Liquid; D005148:Facial Dermatoses / Q000139:chemically induced / Q000473:pathology; D005500:Follow-Up Studies; D006801:Humans; D017495:Hyperpigmentation / Q000139:chemically induced* / Q000473:pathology*; D007150:Immunohistochemistry; D008297:Male; D008854:Microscopy, Electron; D008875:Middle Aged; D010787:Photosensitivity Disorders / Q000139:chemically induced / Q000473:pathology; D018570:Risk Assessment; D012720:Severity of Illness Index
D000889:Anti-Arrhythmia Agents; D000638:Amiodarone