Reactions 1121 - 30 Sep 2006

Imipramine

Facial pigmentation: case reportA 45-year-old woman developed cutaneous facial

pigmentation during treatment with imipramine fordepression.

The woman, who had been receiving imipramine150 mg/day for the past 21 years, presented with a facialpigmentation that had started 26 years previously when shewas pregnant and was diagnosed as melanosis. Approximately1 year before presentation, she noticed that her facialpigmentation had markedly worsened, and a bluishdiscolouration had started to develop on her face. Onexamination, she had symmetrically distributed brownishmacules over her forehead and cheeks, and ‘bluish slate gray’pigmentation surrounding her eyes. Her pigmentationextended symmetrically to the left and right sides of her neck.Two punch biopsies of her facial skin were performed. Ahistological section from a facial skin fragment revealedbrownish pigment granules in her upper dermis andsurrounding some dermal small blood vessels that stainedpositively with the Fontana-Masson method. An ultra thinsection showed spindle and oval-shaped electron-densebodies in the cytoplasm of some dermal macrophages.

Imipramine was replaced by sertraline. On examination2 months later, the woman had mild fading of her facial skinpigmentation. She reported that her facial pigmentation hadessentially completely faded approximately 1 year later.

Author comment: "Imipramine or its metabolite may beexcited by light energy to activate tyrosinase, resulting inincreased melanin and trapping of imipramine free radicals."Metelitsa AI, et al. Imipramine-induced facial pigmentation: case report andliterature review. Journal of Cutaneous Medicine and Surgery 9: 341-345, No. 6,Dec 2005 - Canada 801046029

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Reactions 30 Sep 2006 No. 11210114-9954/10/1121-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved