What Drug Causes Darkening Of Skin That Drug Users Use

Standing Education Activity

Drug-induced pigmentation represents a complex result for patients who are prescribed sure medications. These medications may include NSAIDs, tetracyclines, antimalarials, heavy metals, etc. This activity reviews the etiology, epidemiology, pathophysiology, and treatment for drug-induced pigmentation. This activeness will present an overview of the etiology, clinical findings, and potential therapeutic factors that are important for members of the interprofessional team in the treatment of patients with drug-induced pigmentation.

Objectives:

Identify the etiology of drug-induced pigmentation.
Review the history and physical test of a patient with drug-induced pigmentation.
Summarize the handling and direction options available for drug-induced pigmentation.
Outline interprofessional squad strategies for improving care coordination and communication to advance drug-induced pigmentation and improve outcomes.

Access free multiple option questions on this topic.

Introduction

Drug-induced pigmentation is a form of abnormal skin pigmentation that is caused by drugs through several different mechanisms. Several drugs have associations with pigmentation, including cytotoxic agents, analgesics, anticoagulants, antimicrobials, antiretrovirals, metals, and antiarrhythmic, etc. Diverse causes tin can contribute to the pigmentation that may involve an accumulation of melanin synthesis or even the synthesis of particular substances. Histological findings are relatively diverse just can include substances that are primarily within the dermal macrophages. Diagnosing a patient with drug-induced pigmentation can be difficult, as information technology is essential to rule out other conditions that may be leading to the skin findings.

Additionally, it is especially difficult to make the diagnosis in patients on multiple drugs. The recommendation is to perform a complete medical history, along with a thorough skin examination on the patient. The hope is that there will exist more research on the specific effects of drug-induced pigmentation and potential handling options.

Etiology

Drug-induced pigmentation is the diagnosis when the pigmentation is temporally associated with drug use, and other potential causes have been ruled out. Several drugs can cause pigmentation from antimalarials to antiretrovirals. Therefore, clinicians should be vigilant in examining a patient's total medical history to make up one's mind the specific drug that appears to be causing the patient'southward symptoms.[1]

Epidemiology

The incidence of drug-induced pigmentation is difficult to ascertain because of a lack of reported cases and a dearth of information from patients regarding their treatment. However, estimates are that virtually twenty% of cases of pigmentation are thought to be drug-induced. No meaning differences betwixt gender, age, and racial groups have been noted, although individuals with darker skin may brandish more astringent hyperpigmentation.[two] More prospective studies investigating this outcome are needed.[1][3]

Pathophysiology

The pathophysiology of drug-induced pigmentation is thought to involve several different mechanisms. It could be due to the aggregating of melanin (eastward.yard., antimalarials), either past a direct trigger of the medication or nonspecific inflammation caused by the drug. This class of pigmentation is worsened by sun exposure, explaining patients' worsened pigmentation in sunny areas. Additionally, the drug itself can accumulate and crusade pigmentation. The drug can remain within dermal macrophages and fifty-fifty undergo chemical changes to newer types of particles, as exhibited by gilt complexes. Finally, the last 2 mechanisms for drugs that can cause pigmentation involves the synthesis of new pigment (lipofuscin) or accumulation of atomic number 26 (minocycline).[iv] The latter is thought to involve damaged blood vessels and lysis of cherry claret cells.[3]

History and Physical

In regards to clinical findings, drug-induced pigmentation varies from other causes of pigmentation. The most crucial stardom is that when the treatment with the drug stops, the pigmentation also begins to fade. For example, with the discontinuation of paclitaxel, the pigmentation too resolves shortly thereafter.[5] The discoloration associated with drug-induced pigmentation also tends to have a slower occurrence, with gradually worsening over months to a year. Moreover, particular drugs may have specific patterns of pigmentation. For example, NSAIDS typically involve fixed eruptions, whereas psychotropics are known for presenting with a blue-greyness appearance and are related to sun exposure. Certain drugs are also associated with nail pigmentation. For case, antimalarials are more probable to crusade blast beds that have transversal bands, whereas cytotoxic drugs such every bit cisplatin are more than likely to nowadays with longitudinal pigmented bands.[3] See the tabular array for an overview of the characteristic pigmentation findings associated with particular drugs.

Evaluation

When evaluating whether a patient has pigmentation related to medication utilise, it is crucial to accept into consideration several points. First, information technology is vital to take a thorough medical history of the patient, which involves noting all the medications the patient is taking and carefully evaluating whatsoever that have pigmentation-related side effects. Common drugs that are known to cause pigmentation include NSAIDS, antimalarials, amiodarone, anticoagulants, antimicrobials, antiretrovirals, and tetracyclines. Additionally, a provider should note when the pigmentation starts and if there are any changes, such equally increased or decreased intensity, later altering the usage of the drug. For example, amiodarone-induced pigmentation exhibits a dose-dependent human relationship in regards to its advent.[6]

Treatment / Management

Initially, if in that location is another drug that tin can substitute as therapy for the patient's condition, then that should be a consideration. If that is not possible, an constructive arroyo involves reducing the dosage of a drug. Some drugs such as amiodarone have a dose-dependent correlation with the corporeality of discoloration experienced.[3] In these cases, decreasing the intake of a drug can dramatically reduce the dyschromia present. Additionally, specific drug-induced pigmentation is avoidable by limiting dominicus exposure. These drugs include antimalarials, psychotropic, amiodarone, and tetracyclines.[3] In these cases, patients should receive counsel on proper exterior wear, such as sunglasses and protective, covered clothing. If the suggestions mentioned above failed to piece of work, there are also some topical and laser treatments available. However, the efficacy of these treatment methods remains elusive.

Differential Diagnosis

Several pigmentation-related skin weather should merit consideration before a diagnosis of drug-induced pigmentation is made. Melasma tin can present equally a light, night brownish discoloration. Addison illness usually involves pigmentation of the oral mucosa. Blue nails are i of the characteristic findings of Wilson disease, which as well includes visceral involvement of other organs such as the liver. Vitamin deficiencies, such as niacin, tin can nowadays with pellagra and the classic triad of dementia, diarrhea, and dermatitis.[7] Finally, Kaposi sarcoma should be on the differential for HIV-infected individuals.

Prognosis

The prognosis of the pigmentation is generally good, but actress-dermal manifestations of the pigmentation may exacerbate it. For example, hydroxychloroquine may cause pigmentation of the oral mucosa, and minocycline tin cause pigmentation of middle valves.[8][9] Otherwise, drug-induced pigmentation does not correlate with increased mortality. There may be psychological or social impacts depending upon the individual patient.

Complications

The complications and associated symptoms of the pigmentation depend on the specific drug. NSAIDs are known to cause fixed drug eruptions, most probably through a hapten-blazon interaction. Antimalarials, amiodarone, and antipsychotics involve bluish to gray discoloration in various areas from the face to the lower extremities. Anticonvulsants can cause brown-grayness discoloration that resembles melasma. The pigmentation can too deposit in other areas such as the nails (antimalarials and minocycline). Antipsychotics, antimalarials, and amiodarone can even lead to corneal pigmentation.[3]

Deterrence and Patient Education

Patient pedagogy is vital in all stages of managing drug-related pigmentation from diagnosis to treatment. Obtaining a thorough medical history is crucial for making a diagnosis of drug-induced pigmentation. Therefore, it is necessary that patients provide a total, authentic history regarding their past and current medication use. Additionally, when removing or adjusting the medication used for treating drug-induced pigmentation, it is essential that the patient correctly understand the new regimen of the medication to avoid farther exacerbation of the pigmentation acquired past the previous drug usage. For drugs that are associated with dominicus exposure, patients should understand the importance of sun protection.[x]

Enhancing Healthcare Team Outcomes

A coordinated endeavour is peculiarly needed when it comes to managing drug-induced pigmentation. Dermatologists need to piece of work with patient's other specialists come up with the best medication or dosage to avoid the pigmentation-related symptoms every bit much as possible. Moreover, future medical providers should be enlightened of the patient's history of drug-relate pigmentation so that they can be mindful of the issue when prescribing new medications.

Addressing pigmentation secondary to drug therapy requires an interprofessional team arroyo, including physicians, specialists, specialty-trained nurses, and pharmacists, all collaborating across disciplines to achieve optimal patient results. [Level Five]

Review Questions

Figure

Drug Induced Pigmentation. Contributed by Shahzeb Hassan

References

ane.: Nahhas AF, Braunberger TL, Hamzavi IH. An Update on Drug-Induced Pigmentation. Am J Clin Dermatol. 2019 February;20(1):75-96. [PubMed: 30374894]
2.: Halder RM, Nandedkar MA, Neal KW. Pigmentary disorders in ethnic skin. Dermatol Clin. 2003 October;21(four):617-28, vii. [PubMed: 14717403]
iii.: Dereure O. Drug-induced skin pigmentation. Epidemiology, diagnosis and treatment. Am J Clin Dermatol. 2001;2(iv):253-62. [PubMed: 11705252]
4.: Bong AT, Roman JW, Gratrix ML, Brzezniak CE. Minocycline-Induced Hyperpigmentation in a Patient Treated with Erlotinib for Non-Small Prison cell Lung Adenocarcinoma. Case Rep Oncol. 2017 Jan-Apr;ten(i):156-160. [PMC free commodity: PMC5346923] [PubMed: 28413391]
v.: Cohen PR. Paclitaxel-associated reticulate hyperpigmentation: Study and review of chemotherapy-induced reticulate hyperpigmentation. World J Clin Cases. 2016 Dec xvi;4(12):390-400. [PMC gratis article: PMC5156876] [PubMed: 28035312]
6.: Kounis NG, Frangides C, Papadaki PJ, Zavras GM, Goudevenos J. Dose-dependent appearance and disappearance of amiodarone-induced pare pigmentation. Clin Cardiol. 1996 Jul;xix(7):592-4. [PubMed: 8818442]
7.: Yamaguchi Y, Hearing VJ. Melanocytes and their diseases. Common cold Leap Harb Perspect Med. 2014 May 01;four(5) [PMC free article: PMC3996377] [PubMed: 24789876]
viii.: Sant'Ambrogio S, Connelly J, DiMaio D. Minocycline pigmentation of centre valves. Cardiovasc Pathol. 1999 Nov-December;viii(6):329-32. [PubMed: 10615019]
9.: Kleinegger CL, Hammond HL, Finkelstein MW. Oral mucosal hyperpigmentation secondary to antimalarial drug therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000 Aug;90(2):189-94. [PubMed: 10936838]
10.: Weiss SR, Lim HW, Curtis G. Slate-gray pigmentation of sun-exposed peel induced by amiodarone. J Am Acad Dermatol. 1984 Nov;eleven(5 Pt ane):898-900. [PubMed: 6512044]

Source: https://www.ncbi.nlm.nih.gov/books/NBK542253/

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