Reactions 746 - 10 Apr 1999

Imipramine

Skin pigmentation: 2 case reportsTwo women, aged 54 and 59 years, developed blue to slate-

grey hyperpigmentation in sun-exposed areas after long-termantidepressant therapy with imipramine.

The first patient had taken imipramine 250mg at bedtime for10 years. She noted hyperpigmentation after 5 years’treatment with this agent. The diffuse hyperpigmentation wasobserved on her cheeks, nose, chin nasolabial folds, dorsa ofher hands, thenar and hypothenar eminences and her wrists.Lighter brown pigmentation was seen on her forearms andlegs.

The second patient developed hyperpigmentation on hercheeks and forehead over a 10-year period after she startedimipramine [dosage not stated].

Biopsy specimens revealed golden brown, round to ovalgranules within dermal cells, with clusters of cells aggregatedaround vessels. The granules stained positive with FontanaMasson. Ultrastructurally, granules were located in histiocytesand fibroblasts and also extracellularly along collagen bundles.The granules were found to contain copper and sulphur.[Patient outcomes not stated.]

Author comment: The hyperpigmentation seen in thesecase reports is considered to be produced by a drug-melanosome complex, possibly caused by chronicphotoactivation.Sicari MC, et al. Photoinduced dermal pigmentation in patients taking tricyclicantidepressants: histology, electron microscopy, and energy dispersivespectroscopy. Journal of the American Academy of Dermatology 40: 290-293, Part2, Feb 1999 - USA 800745962

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Reactions 10 Apr 1999 No. 7460114-9954/10/0746-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved