A 67-year-old male with rheumatoid arthritis and recurrent left prosthetic knee infection due to methicillin-resistant Staphylococcus aureus presented to the clinic. He had been taking minocycline 100 mg orally twice a day for the previous 16 months as chronic suppressive therapy. On physical examination, multiple new bluish-grey macules and patches were seen on bilateral forearms and legs (figures 1 and 2). We diagnosed the patient with an unusually severe form of type II minocycline-induced hyperpigmentation. The patient was not on any other medications known to cause skin pigmentation. Given the classic clinical presentation, a skin biopsy was not done. At the visit, we stopped minocycline and started trimethoprim/sulfamethoxazole.
Minocycline-induced skin hyperpigmentation has been reported to occur in up to 54% of patients receiving long-term minocycline therapy.1 Rarely seen with other tetracyclines, hyperpigmentation is caused by the deposition of minocycline metabolites in affected areas.2 The...
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