Amiodarone hyperpigmentation T78.9

Author: Prof. Dr. med. Peter Altmeyer

Last updated on: 04.06.2021

History
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Vestesaeger et al., 1967

Definition
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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.

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

Etiopathogenesis
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Phototoxically induced lysosomal storage of lipids, amiodarone and amiodarone metabolites

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

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

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

General therapy
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Stopping the triggering medication.

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

Progression/forecast
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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
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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