Drug-induced Hyperpigmentation: Amiodarone, Minocycline, Antimalarial

Drug-induced hyperpigmentation accounts for about 10-20% of acquired skin darkening. It can arise through several mechanisms, such as stimulation of pigment production, accumulation of the drug in the skin, and accumulation of lipofuscin and hemosiderin (from damaged capillaries). The key point is that the colour of the marks (blue-grey, blue, black or yellow-grey) often helps indicate which drug is responsible, and after the drug is stopped the marks usually fade only partly and do not clear completely, so lifelong sun protection is needed. This article explains the common drugs and how to manage the condition.

Amiodarone: blue-grey to blue skin

• Appearance: An anti-arrhythmia drug that turns the skin of the face and other sun-exposed areas blue-grey (slate-grey/blue).

• Frequency: Seen in about 1-10% of people with a high cumulative dose (100-200 grams over several years).

• After stopping the drug: It does not fade completely after the drug is stopped, because lipofuscin and drug metabolites have accumulated. The colour may lighten partly over several years. An eye examination is also advised (corneal microdeposits, light sensitivity).

Minocycline and other drugs

Minocycline (an acne medication) can cause pigmentation in 3 patterns.

• Type I: Blue-black colour within old acne scars (from hemosiderin).

• Type II: Blue-grey colour on the legs and arms (pigment and iron beneath the skin).

• Type III: Brown colour over the whole body (pigment in the epidermis). It may also appear in the whites of the eyes, gums, nails, teeth and thyroid gland.

• Antimalarial drugs: HCQ, chloroquine and quinacrine cause blue-grey-yellow colour on the legs, arms and trunk, and quinacrine turns the whole skin yellow.

• Heavy metals: Silver (argyria) gives blue-grey skin all over the body, gold (chrysiasis) gives blue-grey colour in sun-exposed areas, and arsenic causes darkening together with keratosis.

• Chemotherapy drugs: Busulfan (bronze skin all over the body), hydroxyurea (darkening of the nails/skin), 5-FU and doxorubicin (streaky marks), bleomycin (flagellate pattern) and cyclophosphamide (nails/mucous membranes).

Treatment approach

• Stopping the drug: Stop the drug if possible, always after consulting the doctor who manages your condition, because some drugs cannot be stopped (for example, amiodarone in people with severe arrhythmia).

• Fading of the marks: The marks usually fade only partly. For example, amiodarone fades within 2-3 years and minocycline type III within 3-6 months, while types I and II may be permanent.

• Sun protection: Protecting the skin from the sun for life is the most important step.

• Other options: Q-switched lasers work for marks from amiodarone and minocycline type I/II but not for type III, which lies in the epidermis. Depigmenting topical medicines have limited effect on deep marks, and cosmetic camouflage may also be used.

Frequently asked questions

Will the marks go away after I stop the drug? Only partly. Deeper marks may be permanent, depending on the type of drug and how long it was taken.

If it is caused by amiodarone, do I have to stop the drug? You should not stop it on your own. Consult your cardiologist first, because this drug may be necessary, and in some patients there are alternatives.

Can lasers help? Q-switched 1064 nm lasers work on pigment in the dermis, but several sessions are usually needed.

Can it be prevented? It can be reduced by protecting the skin from the sun for life and by using the lowest dose of the drug that still controls the disease, under a doctor's supervision.

Drug-induced hyperpigmentation comes in several types, and some marks may be permanent. Identifying the cause and planning appropriate care are therefore important. If you have unusual skin darkening after taking a drug, consult a dermatologist at Siam Dermatology. Phone +66 61 448 7000 or LINE @siamderm.

Written by Dr. Patara Voravutinon, Dermatologist · Last reviewed 16 July 2026