Skin pigmentation due to drugs is quite common and accounts for 10 to 20% of all cases of acquired hyperpigmentation. Skin pigmentation can be due to variety of drugs that can arise due to direct effects of the drugs as in combination with triggering factors like sun exposure. Out of several drugs some of the most common drugs that cause skin pigmentation are antimalarials drugs, tetracyclines, nonsteroidal anti-inflammatory drugs, cytotoxic drugs, amiodarone, heavy metals and psychotropic drugs.
Treatment of drug induced pigmentation is usually withdrawal from the offending medicine and avoiding sun exposure. It may be accompanied by fading creams for several weeks to help improve the pigmentation.
Tetracyclines Groups
Hyperpigmentation is common in individuals taking tetracycline, especially minocycline. Tetracycline and minocycline may also cause brown discoloration of teeth, so is not recommended in children. Some of the drugs in these groups are:
- Doxycycline
- Demeclocycline
- Minocycline
- Oxytetracycline
- Tetracycline
Heavymetals
The heavy metals are also considered to be causative factors for pigmentation disorders. Presentation may differ from metals to metals but are usually slate-gray or blue-gray in appearance. Some of the heavy metals that may cause pigmentation are below:
- Arsenic
- Bismuth
- Gold (compounds)
- Iron
- Lead
- Mercury
- Silver
Antiretroviral drugs
Antiretroviral drugs can also cause skin and nail pigmentation that may resolve gradually when the drug is withdrawn. These drugs include:
- Indinavir
- Emtricitabine
- Saquinavir
- Zidovudine
Topical medications
There are several topical medications that might cause skin pigmentation, some of which are listed below:
Aminolevulinic acid
Carmustine (BCNU)
Bergamot
Bimatoprost
Carteolol
Chlorhexidine
Imiquimod
Latanoprost
Nitrogen mustard
Tretinoin
Verteporfin
Antihypertensive drugs
Sometimes antihypertensive drugs can also cause pigmentary changes in the skin. Some of the drugs that might cause pigmentation are: that might causes pigmentation on skin are
Acebutolol
Betaxolol
Bisoprolol
Captopril
Clonidine
Diltiazem
Esmolol
Indapamide
Labetalol
Methyldopa
Metoprolol
Minoxidil
Nisoldipine
Propranolol
Spironolactone
Timolol
Antimalarial drugs that can cause pigmentary changes are
Amodiaquine
Chloroquine
Hydroxychloroquine
Pyrimethamine
Quinacrine
Quinine
Anti-fungal agents that can cause pigmentation disorders are
Amphotericin B
Griseofulvin
Ketoconazole
Sertaconazole
Terbinafine
Voriconazole
Chemotherapeutics agents that can cause pigmentation on skin are
Bleomycin
Busulfan
Doxorubicin
Daunorubicin
fluorouracil
cyclophosphamide
carmustine
docetaxel
Bevacizumab
Capecitabine
Carboplatin
Cisplatin
Dactinomycin
Epirubicin
Estramustine
Etoposide
Floxuridine
Fluorouracil
Hydroxyurea
Ifosfamide
Irinotecan
Mechlorethamine
Mercaptopurine
Methotrexate
Mitomycin
Mitotane
Mitoxantrone
Paclitaxel
Pentostatin
Procarbazine
Thiotepa
Vinblastine
Vincristine
Vinorelbine
Immunosuppressive drug
Azathioprine
Cyclosporine
Antiviral Drugs
Ganciclovir
Cidofovir
Foscarnet
Ribavirin
Antidepressants, Antipsychotic and anxiety disorders medications
Phenothiazines
Imipramine
Desipramine
Chlorpromazine
Amitriptyline
Citalopram
Clomipramine
Clonazepam
Diazepam
Fluoxetine
Promazine
Fluvoxamine
Fluphenazine
Haloperidol
Promazine
Perphenazine
Thiothixene
Loxapine
Mesoridazine
Molindone
Olanzapine
Paroxetine
Pimozide
Risperidone
Thioridazine
Antiepilectic
Phenytoin
Carbamazepine
Mephenytoin
Tiagabine
Topiramate
Other drugs acting on Central nervous system
Methamphetamine
Tolcapone
Eletriptan
Donepezil
Anaesthetic drugs, pain reliever and muscle relaxant drugs
Levobupivacaine
Lidocaine
Orphenadrine
Cyclobenzaprine
Leflunomide
Etodolac
Phenazopyridine
Methysergide
Ketoprofen
Pentazocine
Antibiotics that may sometime cause pigmentation are
Ceftriaxone
Enoxacin
Grepafloxacin
Linezolid
Lomefloxacin
Ofloxacin
Sparfloxacin
Sulfadiazine
Anti-tuberculosis and Antileprosy drugs
Rifabutin
Rifapentine
Clofazimine
Dapsone
Hormones
Chlorotrianisene
Corticosteroids
Diethylstilbestrol
Thyroid Hormone to treat hyperthyroidism
Propylthiouracil
Methimazole
Anti-allergic drugs
Promethazine
Cetirizine
Anti-nausea/vomiting,
Metoclopramide
Prochlorperazine
Antiulcer drug
Rabeprazole
Pantoprazole
Retinoids
Isotretinoin
Alitretinoin
Other Miscellaneous Drugs
Amiodarone
Cevimeline
Deferoxamine
Dicumarol
Dinoprostone
Glatiramer
Heroin
Interferon
Methoxsalen
Nicotine
Phenolphthalein
Psoralens
Riluzole
Sulfasalazine
Niacin
Smallpox vaccine
Quinidine
