Amiodarone hyperpigmentation T78.9

Vestesaeger et al., 1967

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. Dermatologic UAWs include slate-gray dyschromias on light-exposed skin areas.

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

Phototoxically induced lysosomal storage of lipids, amiodarone and amiodarone metabolites

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

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

Usually long latency period of at least 10-12 months between first use of amiodarone and appearance of initial symptoms. Initial erythema in about 30-40% of patients, especially on the face. Later, blue or gray dyschromia in light-exposed areas. Skin folds and furrows are usually excluded.

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

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

Stopping the triggering medication.

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

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.

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