Reactions 1326 - 6 Nov 2010

Imipramine

Hyperpigmentation in an elderly patient: casereport

An elderly woman developed hyperpigmentation duringchronic treatment with imipramine for depression.

The 66-year-old woman, who had been receivingimipramine daily for 40 years [dose and route not stated],presented with a 4- to 5-year history of progressive blue-brown discolouration of her neck, face and dorsal surfaceof her hands. The discolouration was noticeable soon aftershe began HRT, which was subsequently discontinued.Imipramine was maintained and the pigmentationworsened gradually, leading to social withdrawal.Examination revealed extensive macular blue-brown topurple hyperpigmentation involving her face, neck, upperchest and, to a lesser extent, her dorsal hands. A golden-brown pigment within tissue macrophages and the dermiswas notable on biopsy, suggestive of medication-inducedhyperpigmentation.

The woman initially received a successful test spot lasertreatment of the right preauricular skin with Q-switchedalexandrite lasers. She subsequently receivedfour treatments to her face and neck over a 6-monthperiod, with marked clearing of the skin. Following herthird treatment, several dark blue macules were evidentalong the temple and left jaw line, which resolved withongoing treatment. She awaits similar treatment for herhand discolouration. Her mental status improved afterresolution of the hyperpigmentation, with no recurrentepisodes for 1 year. Further treatment will probably berequired to maintain resolution, as she insists oncontinuing imipramine.

Author comment: "Although the precise etiology ofimipramine-induced hyperpigmentation is not known, drugmetabolites are believed to deposit in the skin, possiblycomplexed with melanin. The obvious photodistribution ofour patient’s hyperpigmentation supports the theory ofphotoactivation of the imipramine metabolites in producingthe clinically apparent dyspigmentation."Orringer JS, et al. Treatment of imipramine-induced dyspigmentation with Q-switched alexandrite laser therapy. Dermatologic Surgery 36: 1469-1472, No. 9,Sep 2010. Available from: URL: http://dx.doi.org/10.1111/j.1524-4725.2010.01662.x - USA 803043169

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Reactions 6 Nov 2010 No. 13260114-9954/10/1326-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved