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Amiodarone hyperpigmentationT78.9

Author:Prof. Dr. med. Peter Altmeyer

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Last updated on: 05.12.2022

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HistoryThis section has been translated automatically.

Vestesaeger et al., 1967

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

Occurrence/EpidemiologyThis 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.

EtiopathogenesisThis section has been translated automatically.

Phototoxically induced lysosomal storage of lipids, amiodarone and amiodarone metabolites

ManifestationThis 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.

LocalizationThis section has been translated automatically.

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

Clinical featuresThis section has been translated automatically.

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.

HistologyThis section has been translated automatically.

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.

DiagnosisThis 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 therapyThis section has been translated automatically.

Stopping the triggering medication.

External therapyThis 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/forecastThis 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.

LiteratureThis section has been translated automatically.

  1. Dereure O (2001) Drug-induced skin pigmentation. Epidemiology, diagnosis and treatment. Am J Clin Dermatol 2: 253-262.
  2. Dissemond J et al (2003) Hyperpigmentation of the face. Dermatologist 54: 994-998
  3. Drosner M, Worret WI, Marquart KH (1990) Amiodarone hyperpigmentation. Akt Dermatol 16: 67-69
  4. Korting HC, Kolz R, Schmoeckel C, Balda BR (1981) Amiodarone pigmentation. A rare but typical drug side effect. Dermatologist 32: 301-305
  5. Levine N (2004) Grayish discoloration in symmetrical pattern on hands. Drug used for cardiac condition may produce skin problem. Geriatrics 59: 32
  6. Murphy RP, Canavan M. Skin discoloration from Amiodarone. N Engl J Med. 2020 Jan 16;382(3):e5.
  7. Vestesaeger M, Gillot G, Rasson G (1967) Etude clinique d'une nouvelle medication anti-angoreuse. Acta Cardiol 22: 483-500

Authors

Last updated on: 05.12.2022

Author: Prof. Dr. med. Peter Altmeyer