Amiodarone hyperpigmentation T78.9

Author: Prof. Dr. med. Peter Altmeyer

Last updated on: 04.06.2021

History
This section has been translated automatically.

Vestesaeger et al., 1967

Definition
This section has been translated automatically.

Amiodarone (Amiodarex®, Amiohexal®, Cordarex®, Tachydarone®), an iodinated benzofuran derivative, is a potassium antagonist used as a class III antiarrhthmic agent, particularly for supraventricular and ventricular tachycardia. Dermatogenic UAWs include slate gray hyperpigmentation on light-exposed skin areas.

You might also be interested in

Advertisment

Dermatology

Lupus erythematosus acute-cutaneous

Non-scarring, photosensitive, acute to subacute, mostly recurrent manifestation of cutaneous lupus erythema...

Occurrence/Epidemiology
This section has been translated automatically.

0.5-10% of patients treated with amiodarone show dose-dependent discoloration. 0.1-0.3% of patients develop full vision.

Etiopathogenesis
This section has been translated automatically.

Phototoxically induced lysosomal storage of lipids, amiodarone and amiodarone metabolites

Manifestation
This section has been translated automatically.

Dose-dependent occurrence (daily dose usually > 400 mg/day) after excessive but also after uniform tanning. Predominantly men are affected.

Localization
This section has been translated automatically.

Areas exposed to light, especially the face (nose, forehead), ears, back of the hand.

Clinical features
This section has been translated automatically.

Usually long latency period of at least 10-12 months between the first intake of amiodarone and the appearance of initial symptoms. Initial erythema, especially in the face, in about 30-40% of patients. Later blue or grey hyperpigmentation in the area of the light-exposed areas. Skin folds and furrows are usually left out.

Histology
This section has been translated automatically.

Plaque-like perivascular agglomerates of yellow-brown colour complexes (lipofuscin) in the upper dermis. The "degeneration pigment" lipofuscin, a protein and cholesterol-containing mixture of lipo- and argentophilic pigments and is absorbed by lyosomes and histiocytes. Extracellular pigment does not occur.

Diagnosis
This section has been translated automatically.

Reflected light microscopy: Interfollicular, mostly perivascularly localized bluish or brownish grey pigment streaks and plaques. Widening of the horizontal subepidermal vascular plexus.

General therapy
This section has been translated automatically.

Stopping the triggering medication.

External therapy
This section has been translated automatically.

Avoid direct sunlight, textile and physical/chemical sun protection. Cosmetic covering of hyperpigmentations with tinted covering paste (e.g. R025, Dermacolor).

Progression/forecast
This section has been translated automatically.

Hyperpigmentation is only partially reversible in 50-70% of patients. Restitutio ad integrum (approx. 30% of patients) within a period of 2-4 years after discontinuation of the drug.

Literature
This section has been translated automatically.

Dereure O (2001) Drug-induced skin pigmentation. Epidemiology, diagnosis and treatment. At J Clin Dermatol 2: 253-262
Dissemond J et al (2003) Hyperpigmentation of the face. dermatologist 54: 994-998
Drosner M, Worret WI, Marquart KH (1990) Amiodarone hyperpigmentation. Nude Dermatol 16: 67-69
Korting HC, Kolz R, Schmoeckel C, Balda BR (1981) Amiodarone pigmentation. A rare but typical drug side effect. dermatologist 32: 301-305
Levine N (2004) Grayish discoloration in symmetrical pattern on hands. Drug used for cardiac condition may produce skin problem. Geriatrics 59: 32
Vestesaeger M, Gillot G, Rasson G (1967) Etude clinique d'une nouvelle medication anti-angoreuse. Acta Cardiol 22: 483-500