Images in Clinical Medicine
Pigmentation Related to Amiodarone
N Engl J Med 2001; 345:1464November 15, 2001
- Article
Figure 1 A 55-year-old man had blue-gray discoloration of the auricular and periauricular areas of his ears. In 1985, he had had a large anterior myocardial infarction during aortic-valve replacement. Three years later, he had begun to take 400 mg of amiodarone per day for persistent ventricular tachycardia. While taking amiodarone, he began to have photosensitivity, followed by progressive blue-gray pigmentation of areas of his head and face that were exposed to the sun. This pigment has been shown to consist of electron-dense, compact, lamellar granules in the lysosomes of dermal macrophages, similar to lipofuscin. The use of protective clothing and opaque sunscreens was helpful and limited further hyperpigmentation. In 1997, a transvenous cardioverter–defibrillator was implanted, and the dose of amiodarone was decreased to 200 mg per day, five days per week. Twenty months later, the pigmentation had decreased. Complete resolution cannot be expected unless amiodarone is discontinued, in which case the pigment typically clears over a period of months or years.
Whitney A. High, M.D.
Steven D. Weiss, M.D.
Presbyterian–St. Luke's Medical Center, Denver, CO 80218- Citing Articles (2)
