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KEY WORDSclinical image dermatology pharmaceutical care
The differential diagnosis for acquired hyperpigmentation includes melasma, pigmented contact dermatitis, drug-induced hyperpigmentation (DIH), erythema dyschromicum perstans, Addison’s disease, hyperthyroidism, hemochromatosis, and cutaneous malignancies. These disorders generally result from increased melanin, increased melanocytes, or deposition of another discoloring substance in the skin.1 Medications commonly cited as causing hyperpigmentation include prostaglandins, minocycline, phenothiazine, nicotine, and antimalarial drugs.2 MIH typically occurs in a dose-dependent fashion after large cumulative doses of 70–100 g, but may appear within weeks of starting the medication.3 In one study, 17 % of patients taking minocycline developed hyperpigmentation.4 In addition to the skin, MIH can involve the sclera, nails, ear cartilage, bone, oral mucosa, teeth, and thyroid gland.5 Therapy for MIH is cessation of the medication, after which the discoloration may slowly improve. If discoloration persists, laser therapy may also be used.5
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- 5.James WD, ELston DM, Berger TG. Andrews’ diseases of the skin: clinical dermatology. 11th ed. London: Saunders/Elsevier; 2011:126.Google Scholar