Amiodarone - induced skin pigmentation Amiodarone- induced skin pigmentation P. Marko and J. Miljkovic SUMMARY In last year a few cases of blue-gray skin pigmentation in photo exposed areas (face and hands) were observed at our department. Because of a chronic myocardiopathy and arrhythmia, all these patients had taken amiodarone 200 mg daily over more than two years. Histopatholologic examination revealed upper and mid-dermal deposits of a yellow-black granular pigment distributed perivascularly in the cy- toplasm of dermal macrophages. Special staining demonstrated that this pigment has the characteris- tics of lipofuscin. The small number of cases reported are probably due to the fact that this side effect of amiodarone is not so rare but frequently unrecognized. Introduction Amiodarone is a ve1y effective antiarrhythmic drug, however sometimes associated w ith adverse effects in- volving several organs (pulmona1y toxicity, hypothy- roidism, and various neurologic side effects) . Severa! types of pathologic cutaneous reactions have been re- p01ted, including allergic rash, photosensitivity, vasculi- tis and skin pigmentation. Photosensitivity is a side effect that occurs in 30% to 57% of patients on amiodarone and between 1% and 10% show cutaneous hyperpigmenta- tion. Sic!e effect.~ associatec! with amioc!arone use are gen- erally well tolerated and reversible (1,2). Case report In lasts years three cases of blue-gray skin pigmen- tation in photo exposec! areas (face and hands) were observed at our department. Because of chronic myo- cardiopathy anc! arrhythmia, ali these patients had taken amiodarone 200 mg daily over more than two years. Patients Patient 1 (S. A.). This man was bom in 1929 and had ischemic myo- cardiopathy. Due to attacks of atrial fibrillation w hich remainecl unaffectec! by conventional antiarrythmic drugs he was in 1997 given Cordarone in a dose of 200 mg daily. Late in summer 1998, after having taken Cordarone for one year, he noticed a blue-grey discol- oration of his face and extensor surfaces of the hancls. In spite of this side effect , the patient continuecl with his meclication ancl a slight worsening of the skin le- sion was noticecl. (Fig.1) Patient 2 ( D. R.). The male patient was bom in 1931. In 1994, after an acute myocarcl ial infarction he experienced frequent attacks of atrial fibrillation with symptoms and signs of carcliac ischemia. He was given Corclarone 200 mg three times claily fo r a week, then a maintenance close of 200 Cas e r e port 11 O - - --------------------------------Acta Dermatoven APA Vol 11, 2002, No 3 Case report Figure 1. Patient 1. Greyish color of the face due to amiodarone tretment. mg daily. Because of arterial hypertension, hyperlipi- demia and peripheral vascular disease, his medica! treat- ment also included enalapril, furosemid, simvastatin and acetylsalicylic acid. After having taken Cordarone for six years, he noticed inhomogeneous dirty discolora- tion of face and hands. In February 2001, his cardiolo- gist noticed a worsening of skin discoloration and Cordarone treatment was discontinued. Patient 3 (H. M) The female patient, bom in 1939, started the therapy with Cordarone in 1999 in a