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Minocycline Pigmentation

2007-07-05

Minocycline-Induced Pigmentation

Minocycline

Common brand names: Minocin, Dynacin.

Background:

Incidence:

Sites of involvement:

Oral cavity

Skin

Nails

Eyes

Thyroid

Other

Management

Prognosis:

I.A. Hargitai
Pigmentation usually resolves when the drug is removed, however, it may persist indefinitely.: There is no treatment for alveolar pigmentation. Skin lesions may be minimized with Q-switched laser. Prevention as management: Minimize the cumulative dose of minocycline. Discontinue after 6 months. Acne and rosacea can be treated with other medications. : Breastmilk, skeleton, cartilage. No adverse effects have been reported on the structure or function of bone.: One case report of minocycline-induced hypothyroidism. May be prudent to check thyroid function if on long-term therapy. No evidence to support checking hepatic and renal function at this time: A 3-5 mm blue-gray band in the sclera has been reported. When the eyes are involved, invariably the nails are also involved.: Infrequent. May impart a slate-gray color to the nailbed.: Ankle is most common location. May be brown, blue, black, or gray.: The teeth, the mucosa, or the underlying alveolar bone may all be involved. When the teeth are affected, minocycline imparts a grayish-blue stain. Crown involvement is rare, but root involvement is common. Staining of the mucosa is also rare. Actually, almost all cases of oral pigmentation due to minocycline involve the underlying alveolar bone (black bone disease). Overall, intraoral bone represents the body site most commonly involved. Bony pigmentation is irreversible. About 15% of patients developed minocycline induced pigmentation in one study. Generally, taking cumulative doses of 100 g or more of minocycline puts one at risk for developing pigmentation, however, it may develop at any dose. Minocycline is a semi-synthetic, broad-spectrum tetracycline type antibiotic. It is highly bound to plasma-proteins and is lipid soluble. Thus it can penetrate into body fluids such as saliva and breastmilk. The salivary concentration of minocycline is 5-fold higher than its serum concentration. Of all the tetracyclines, minocycline is the one most commonly associated with inducing pigmentation of the skin, oral mucosa, and bones.Drore E, Hakim MD, Drug Safety, 18(6):431-40, 1998.



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