Minocycline hyperpigmentation

Several recent studies have documented the efficacy and safety of minocycline in the treatment of mild rheumatoid arthritis. Reported side effects tend to be mild, with gastrointestinal disturbances, headaches, vestibular dysfunction, and photosensitive rashes being the most common. Hyperpigmentation of skin and other structures has also been reported but seems to be uncommon and usually dose-related. The different types of skin hyperpigmentation are reviewed, including their histopathologic and clinical distinctions, possible predisposing factors, and treatment. Our experience suggests that steroid use, advanced age, cumulative minocycline dosage, and possibly the brand of minocycline may be predisposing risk factors for developing hyperpigmentation. It is quite possible that this adverse effect is more common than previously recognized, and we suggest that physicians prescribing minocycline be observant for skin hyperpigmentation. Although most of our patients with hyperpigmentation chose to continue the medication (61%), it must be discontinued for the hyperpigmentation to resolve.