title: Minocycline-induced hyperpigmentation in multibacillary leprosy.
abstract: Minocycline has been used in the treatment of leprosy since the demonstration of its efficacy in inhibiting Mycobacterium leprae growth in 1987. Hyperpigmentation, a well-documented adverse effect, classically shows 3 clinical and histological patterns: type I consists of blue-black pigmentation in areas of current or previous inflammation, type II consists of blue-gray pigmentation of normal skin, often seen on the legs, and type III consists of diffuse muddy-brown pigmentation accentuated on sun-exposed sites. Whereas type I hyperpigmentation stains positively for hemosiderin and type III hyperpigmentation stains positively for melanin, type II hyperpigmentation stains positively for both. We describe 2 patients with leprosy on minocycline therapy who developed multiple patches of blue-gray pigmentation within preexisting leprosy lesions. Biopsies from both patients demonstrated deposition of brownish-black pigment granules within the cytoplasm of foamy histiocytes that was highlighted by both Perls and Fontana-Masson stains. Given the clinical and histological findings in our patients, it is as yet unclear whether this coexistent type I clinical pattern and type II histopathologic pattern of pigmentation is unique to multibacillary leprosy. These findings provide support for the existence of additional subtypes of minocycline-induced hyperpigmentation that do not adhere to the classic 3-type model described.
authors.affiliation: Department of Dermatology, New York University, New York, NY 10016, USA. stephwhu@gmail.com
authors.forename: Stephanie W
authors.initials: SW
authors.lastname: Hu
authors.forename: Maria R
authors.initials: MR
authors.lastname: Robinson
authors.forename: Tracey
authors.initials: T
authors.lastname: Newlove
authors.forename: Shane
authors.initials: S
authors.lastname: Meehan
authors.forename: William R
authors.initials: WR
authors.lastname: Levis
authors.forename: Rishi R
authors.initials: RR
authors.lastname: Patel
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D017495:Hyperpigmentation / Q000139:chemically induced* / Q000473:pathology*; D056006:Leprosy, Multibacillary / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents; D008911:Minocycline