Long-Term Minocycline Treatment May Turn Your Skin Blue

By Seppo | Acne drugs

OK, sorry about the sensational headline, I just couldn’t resist. Especially since there’s a grain of truth to it. I just came across case reports and papers reporting skin hyperpigmentation after minocycline treatment. These describe people who have developed blue/gray areas on their skin following minocycline treatment. Apparently this not so common but also not rare side-effect has been known since 1978.

What does it look like

Here are two cases that developed around acne scars, apparently this sort of hyperpigmentation can develop even after fairly short treatments (more on that later).

minocycline-hyperpigmentation

Source: A new type of minocycline-induced cutaneous hyperpigmentation

Here’s another case that developed for an older man who took minocycline for rheumatoid arthritis.

minocycline-hyperpigmentation-2

Source: Minocycline-induced hyperpigmentation: comparison of 3 Q-switched lasers to reverse its effects.

As you can see from the image on the left, most of the face is covered with dark patches. The image on the right shows more normal looking skin, after laser treatment.

Here’s yet another case.

drug_induced_hyperpigmentation-7

Source: Drug-induced Hyperpigmentation

In short, it’s not pretty. I’m not sure which one is worse, this or acne.

When does this happen?

The good news is that these side-effects are not that common. The bad news is that there’s no clear relationship between treatment dosage and duration and occurrence of hyperpigmentation.

Here are some things we can say:

  • Based on the few studies available, this kind of hyperpigmentation occurs in 2.4 to 14.8% of patients on long-term minocycline treatments (3 months of more).
  • The risk increases with dosage. Papers mention 100 mg/day or more as risk dosage. Unfortunately this fall right in the middle of common acne treatment dosages, which are 100 to 200 mg/day for treatment and 50 to 100 mg/day for maintenance.
  • This happens far more often in patients on long-term treatments, usually 3 months or more. One paper noted that 50% of people who were treated for 3 years or more developed hyperpigmentation.
  • The risk probably increases with age.
  • Unprotected sun exposure may also increase your risk.
  • All the reports deal with minocycline. I can’t say whether something like this can happen with other antibiotics.

That said, some cases have been reported with treatments as short as 20 days. Apparently, hyperpigmentation around acne scars (see the first images) is more common after shorter treatments than hyperpigmentation that affects unscarred skin.

Affected areas

This kind of discoloration isn’t limited to skin, it can also affect nails and nail bed, teeth, mouth, internal organs and even mother’s milk.

How long it lasts

In many cases discoloration fades over time, but this can take months or years. The first pictures were taken 43 months after the discoloration happened. Some papers also mention this is permanent.

Is there anything you can do about it?

Fortunately, yet. I couldn’t find any studies on this, but there are several case reports of these being successfully treated with different laser treatments.

Conclusion

I don’t want this post to sound like fear-mongering. I had never heard of this before, dermatologists had never mentioned this possibility to me. So when I came across these case reports, I wanted to tell you about it. This, I believe, is information you should have when considering antibiotic treatments for acne. Especially since most people believe antibiotics are more or less harmless.

But these reports show that minocycline treatment for acne carries a small, but not insignificant, risk of staining your skin.

In case you are thinking of antibiotic treatment, you should also see this post: Acne Antibiotics – Short Term Gain With Long Term Harm.

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About the Author

Seppo Puusa, a.k.a. AcneEinstein shares rational advice about natural and alternative acne treatments. Read more about me and my acne struggles at the page.

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