REVIEW – February 2003

A rare side effect of Amiodarone – hyperpigmentation of skin


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Drug-induced pigmentation accounts for 10 to 20 % of all cases of acquired hyperpigmentation and this hypothesis must be systematically raised in unexplained pigmented lesions. Amiodarone (Cordarone) is a drug with an iodinated compound used widely in treatment of cardiac arrhythmias. Amiodarone has several side-effects including development of slate-grey discolouration of the sun-exposed skin. In the pathophysiology of this discolouration an important role is played by dermal macrophages phagosytosizing the highly lipid soluble amiodaron or its metabolite molecules.
In the current paper a case report is presented of a patient with hyperpigmentation since 1988 when he started to use Cordarone because of cardiac arrhythmias after myocardial infarction. All other causes of hyperpigmentation were ruled out. The skin biopsy was taken and it showed greish-brown granules in the cytoplasm of the macrophages in the reticular dermis, which is characteristic of pigmentation due to amiodarone. Treatment options include decreasing the amiodarone dosage or discontinuing the drug, which will result in resolution of the pigmentation over time. During treatment with amiodarone it is necessary to use sun protective ointments with UVA and UVB filters to avoid development of pigmentation. Reports of other treatment options have suggested use of the Q-switched ruby laser and, topically, hydroquinone 2% ointment which is a local bleaching compound.