Unusual Skin Pigmentation From Long-term Methacycline and Minocycline Therapy

To the Editor.—  We read with interest the editorial review in the May 1985 issue of the Archives by Basler¹ on minocycline-related hyperpigmentation. We herein report a case of unusual pigment deposition in elastotic dermal collagen and skin discoloration as a result of long-term therapy with methacycline hydrochloride and minocycline hydrochloride.

Report of a Case.—  A 69-year-old man with a spastic-type neurogenic bladder was treated with methacycline hydrochloride (300 mg/day) in 1959 for the management of urinary bladder infection. In 1979, the dosage was reduced to 200 mg of minocycline hydrochloride daily. In 1984, he presented to a dermatologist with progressive violaceous discoloration of his cheeks and right leg, that he had noted for four to five years.On clinical examination, the cheek pigmentation was similar to lesions of the "muddy skin syndrome,"² which Basler described as the third form of minocycline-related skin pigmentation (Fig 1). The right