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Previous Volume 340:1597-1598 May 20, 1999 Number 20 Next

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To the Editor: The medical mystery in the April 1 issue¹ involved a 79-year-old woman, shown here in Figure 1, who had had discoloration of her face and eyes for several months. Examination revealed bluish pigmentation of her sclerae and skin. For five years she had been taking minocycline (100 mg daily), prescribed for rosacea by her family doctor. She was taking no other medication. The pigmentation is a recognized side effect of minocycline therapy and is thought to be related to the deposition of insoluble complexes of the drug. Similar pigmentation may occur with the use of amiodarone, phenothiazines, antimalarial agents, and some metals. Two years after this patient stopped taking minocycline, there was only a slight decrease in the discoloration.

View larger version (109K): [in this window] [in a new window]   Figure 1. The Photograph of the Woman with Discoloration of Her Sclerae and Skin.

 

Andrew McD. Johnston, M.B., Ch.B.
Aberdeen Royal Infirmary
Aberdeen AB25 2ZN, United Kingdom

Aamir A. Memon, M.D.
Southport and Formby District General Hospital
Southport PR8 6PN, United Kingdom

Editor's note: Only 7 percent of readers who suggested explanations for the discoloration gave treatment with minocycline as the cause, and just half these readers inferred that the antibiotic had been given to treat acne rosacea. Approximately 28 percent guessed that amiodarone was the culprit. Another 19 percent made a diagnosis of argyria. In fact, the pigmentation in patients with argyria has a very different color, as the Image in Clinical Medicine on page 1554 of this issue of the Journal illustrates.¹ Miscellaneous explanations included ochronosis, discoloration from the use of makeup, and pressure from a scuba mask.

References

1. Johnston AM, Memon AA. A medical mystery. N Engl J Med 1999;340:1011-1011. [Free Full Text]
1. Bouts BA. Argyria. N Engl J Med 1999;340:1554-1554. [Free Full Text]

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