title: Minocycline-Induced Cutaneous Hyperpigmentation in an Orthopedic Patient Population.
abstract: Background.  The objectives of this study were to estimate the incidence and evaluate risk factors for development of minocycline-induced cutaneous hyperpigmentation in patients with orthopedic infections. Methods.  Patients with orthopedic infections evaluated at Mayo Clinic (Rochester, MN) and treated with minocycline from 1 January 2002 to 31 December 2011 were retrospectively identified. Long-term minocycline suppression was defined as daily minocycline use for at least 3 months. A proportional hazards model was used to evaluate potential risk factors. Results.  Of 291 patients receiving long-term minocycline suppression, 54% (156 of 291) developed hyperpigmentation after a mean follow-up of 4.8 years (range, 0.3-13.2 years); 88% involved blue-gray pigmentation of normal skin that appeared most commonly in the lower (75%) and upper extremities (44%). The mean duration of minocycline therapy before hyperpigmentation was 1.5 years (range, 0.1-9 years) with a mean cumulative dosage of 107.3 g (range, 8.6-657 g). Notable risk factors include a history of vitamin D deficiency (relative risk [RR], 6.29; 95% confidence interval [CI], 1.91-15.27; P = .0052), presence of a shoulder prosthesis (RR, 3.2; 95% CI, 1.23-6.56; P = .0062), noncirrhotic liver pathology (RR, 3.63; 95% CI, 1.11-8.75; P = .0359), and use of a concurrent medication also known to cause hyperpigmentation (RR, 4.75; 95% CI, 1.83-10.1; P = .0029). Conclusions.  Hyperpigmentation associated with the use of long-term minocycline suppression in patients with orthopedic infections is common.
authors.affiliation: Division of Infectious Diseases , Mayo Clinic , Rochester, Minnesota.
authors.forename: Yuri
authors.initials: Y
authors.lastname: Hanada
authors.affiliation: Division of Infectious Diseases , Mayo Clinic , Rochester, Minnesota.
authors.forename: Elie F
authors.initials: EF
authors.lastname: Berbari
authors.affiliation: Division of Infectious Diseases , Mayo Clinic , Rochester, Minnesota.
authors.forename: James M
authors.initials: JM
authors.lastname: Steckelberg
keywords: antimicrobial side effects; minocycline; orthopedic infections
references.citation: J Rheumatol. 2006 Jul;33(7):1254-7
references.pmid: 16758512
references.citation: Clin Dermatol. 2010 Nov-Dec;28(6):663-8
references.pmid: 21034990
references.citation: JAMA. 1980 Sep 5;244(10):1103-6
references.pmid: 6447805
references.citation: Lasers Surg Med. 1998;22(4):223-7
references.pmid: 9603284
references.citation: Arch Surg. 2012 Apr;147(4):373-83
references.pmid: 22508785
references.citation: J Clin Rheumatol. 2008 Feb;14(1):17-20
references.pmid: 18431092
references.citation: J Am Acad Dermatol. 2007 Nov;57(5):836-9
references.pmid: 17939935
references.citation: Clin Exp Dermatol. 2004 Jan;29(1):8-14
references.pmid: 14723711
references.citation: Int J Dermatol. 2012 Mar;51(3):250-62
references.pmid: 22348557
references.citation: Cutis. 2004 Nov;74(5):293-8
references.pmid: 15605966
references.citation: Dermatol Surg. 2004 Sep;30(9):1201-4
references.pmid: 15355359
references.citation: Arch Dermatol. 1980 Nov;116(11):1262-5
references.pmid: 6449178
references.citation: Am J Clin Dermatol. 2003;4(5):307-14
references.pmid: 12688836
references.citation: J Am Acad Dermatol. 2003 Jul;49(1 Suppl):S1-37
references.pmid: 12833004
references.citation: Arch Dermatol. 1996 Oct;132(10):1251-3
references.pmid: 8859046
references.citation: J Antimicrob Chemother. 2006 Aug;58(2):256-65
references.pmid: 16816396
references.citation: Br J Dermatol. 1993 Aug;129(2):158-62
references.pmid: 7654575
references.citation: J Esthet Dent. 1998;10(4):182-6
references.pmid: 9893512
references.citation: Br J Dermatol. 1996 Apr;134(4):693-5
references.pmid: 8733373
references.citation: Clin Cosmet Investig Dermatol. 2013 May 31;6:159-62
references.pmid: 23754872