A 55-year-old woman presented with bilateral asymptomatic bluish lesions on the inferior tarsal conjunctiva (
image A, arrows). Her medication included 100 mg of minocycline daily for the past 4 years to manage acne and rosacea. Cutaneous examination revealed subtle bluish hyperpigmentations on her face and left prepatellar region (
image B, arrows). To prevent further hyperpigmentation, minocycline was discontinued.
Minocycline is the most lipophilic of the tetracycline agents, and this characteristic is responsible for its excellent tissue penetration. Minocycline-induced hyperpigmentation can affect the skin, nails, teeth, oral mucosa, bones, thyroid gland, conjunctiva, and sclera.
1,2 Conjunctival pigmentation from minocycline is typically seen within palpebral conjunctival inclusion cysts.
3 Early recognition of minocycline-induced hyperpigmentation is important to prevent permanent cutaneous discoloration.
1 Potential risk factors for hyperpigmentation include a history of vitamin D deficiency, noncirrhotic liver disease, and concurrent use of other medications that can cause hyperpigmentation.
4 Cutaneous hyperpigmentation may fade years after minocycline cessation, but ocular and internal visceral hyperpigmentation is typically permanent.
1,2