5 Ways Medications Cause Dark Spots (& a List of Ones to Avoid!)

White pills spilling out of bottle on blue background | 19 Medications That Cause Dark Spots | Masterpiece Skin Restoration

Medications can cause dark spots.

Some medications cause dark spots called hyperpigmentation. But not everyone who takes the medications knows about these side effects. Take my neighbor, Lynn (not her real name), for example. She came to me complaining of dark spots on her face. Lynn thought they might be from taking the pill, but she wasn't sure. She didn't know that drugs that affect women's hormone levels can cause a "mask of pregnancy."

Taking the pill daily, maintains a constant level of estrogen and progesterone, so that ovulation stops. The hormones of pregnancy, which the pill mimics, continuously trigger hyperpigmentation (See our blog post on Melasma Treatment.).

The pill is a VERY common cause of dark spots in women.

About 30% of women using oral estrogen report having melasma like facial pigmentation. Treatment of hormone-induced melasma works best after breastfeeding has stopped, a woman is no longer pregnant, or her contraceptives have changed. In most cases, once the pill is stopped, the dark spots fade. BUT in some cases, the pigmentation may last a long time or become permanent. In all cases, it is important to wear sunscreen and avoid sun exposure.

It's thought that drugs could be the cause of anywhere from 10 - 20% of the cases of hyperpigmentation. A study published in the Indian Dermatology Online Jounal in 2014 found that the most common causes were:

  • nonsteroidal anti-inflammatory drugs
  • antimalarials
  • amiodarone
  • chemotherapeutic agents
  • psychotropic drugs
  • zidovudine
  • tetracyclines
  • heavy metals
Closeup of hands holding pills, wearing medical uniform, stethoscope | What are antioxidants? | Masterpiece Skin Restoration

5 Ways Medications Cause Dark spots:

1. Some drugs cause photosensitivity. That is skin inflammation caused by sunlight in combination with medications. This reaction causes red skin that looks like a sunburn.

2. Some medications cause an allergic reaction called a fixed drug eruption. Unfortunately, scientists don't fully understood how or why it happens. Round or oval, red, swollen patches appear that sometimes blister. The lesion reoccurs in the same place each time the drug is taken. With each dose, the number of lesions may increase. The rash or blister can leave a dark spot that, over time, fades to a purple or brown color.

3. Other drugs cause discolorationThis type of hyperpigmentation is caused by a reaction between the medication and your skin. It usually occurs on the face, and especially around the mouth. It can also affect other parts of the body.

4. Heavy metals, like iron, can cause dark spots. How are people exposed to heavy metals? Colloidal silver products are usually sold as dietary supplements. Other heavy metals may be contaminants in supplements. Silver, mercury, or gold, can become lodged within the skin.

They alter skin color without affecting melanin (which gives your skin it's color) production. In some cases, after damage to blood vessels, iron is released. If large quantities are deposited in the skin's dermal layer, you get a distinct change in skin color. The iron itself becomes visible in the skin - and is NOT a result of increased melanin production.

5. Some oral medications actually cause separation of your nail from the nail bed called photo-onycholysis. It often comes with a rash; but sometimes the nail detachment is the only sign of phototoxicity caused by tetracycline in people with dark skin.

Which medications can cause dark spots?

  1. Non-steroidal anti-inflammatory drugs (NSAIDs): ibuprofen, ketoprofen, celecoxib, sulindac, naproxyn, etodolac
  2. Anesthetics / Pain Medications:  levobupivacaine, lidocaine, orphenadrine, cyclobenzaprine, leflunomide, phenazopyridine, methysergide, pentazocine
  3. Anti-yeast medications: nystatin
  4. Antiretrovirals (like for HIV): Azidothymidine (AZT or zidovudine), Emtricitabine (FTC), indinavir, emtricitabine, saquinavir
  5. Antivirals:  ganciclovir, cidofovir, foscarnet, ribavirin
  6. Pain relievers: fiorinal (migraine headaches), salicylates (aspirin)
  7. Anti Ulcers:  rabeprazole, pantoprazole
  8. Heavy metals: gold, silver, bismuth, arsenic, mercury, lead, and iron
  9. Antibiotics: ceftriaxone, tetracycline, doxycycline, enoxacin, linezolid, minocycline, metronidazole, penicillin, fluoroquinolones (ciprofloxacin, ofloxacin, levofloxacin, lomefloxacin, grepafloxacin, sparfloxacin), sulfadiazine & sulfonamides (Bactrim)
  10. Laxatives: phenolphthalein
  11. Oral contraceptives
  12. Hormone Replacement Therapy:  chlorotrianisene, diethylstilbestrol
  13. Antihypertensives and heart medications: diltiazem, quinidine, procainamide, hydralazine, amiodarone (causes a blue-green pigmentation), angiotensin converting enzyme (ACE) inhibitors like captopril, verapamil, acebutolol, betaxolol, bisoprolol, captopril, clonidine, esmolol, labetalol, methyldopa (Aldomet), metoprolol, minoxidil, nisoldipine, propranolol (Inderal) and timolol
  14. Antidepressants, anti-anxiety and antipsychotic medications: amitriptyline (Elavil), phenothiazines, imipramine, desipramine, citalopram, chlorpromazine, chlorprothixene, clomipramine, clonazepam, diazepam, fluoxetine, fluphenazine, fluvoxamine, haloperidol, loxapine, mesoridazine, molindone, olanzapine, paroxetine, perazine, perphenazine, pimozide, promazine, risperidone, thioridazine and thioxanthenes (chlorprothixene, thiothixene)
  15. Anti-malarial and lupus medications: chloroquine, hydroxychloroquine, clofazimine
  16. Diuretics or water pills: Furosemide, hydro-chlorothiazide (HCTZ), spironolactone, indapamide
  17. Antiepileptics can cause melasma like pigmentation of the face:  carbamazepine, mephenytoin, phenobarbitol, ezogabine, tiagabine, topiramate and especially Phenytoin (dilantin)
  18. Cancer drugs: bleomycin, busulfan, bevacizumab, capecitabine, carmustine, carboplatin, cetuximab, cisplatin, cyclophosphamide, dabrafenib, dacarbazine, dactinomycin, daunorubicin, dibromomannitol, docetaxel, doxorubicin, erlotinib, epirubicin, estramustine, etoposide, 5-fluorouracil (5-FU), floxuridine, gefitinib, hydroxyurea, ifosfamide, imatinib, irinotecan, lapatinib, mercaptopurine, mechlorethamine, methotrexate, mitomycin, mitotane, mitoxantrone, sorafenib, paclitaxel, panitumumab, pentostatin, procarbazine, thiotepa, topical nitrogen mustard, vandetanib, vemurafenib, vinblastine, vincristine, vinorelbine
  19. Photodynamic therapy prophoto-sensitizers for skin cancer, and some acne:  5-aminolevulinic acid, methyl-5-aminolevulinic acid, verteporfin and photofrin
  20. Psoralens for treatment of skin conditions such as vitiligo, eczema, psoriasis and skin problems related to certain lymphomas
  21. Topical hydroquinone for treatment of hyperpigmentation
  22. Allopurinol for gout
  23. Quinine for leg cramps
  24. Retinoids: oral isotretinoin for acne and oral acitretin for psoriasis
  25. Statins for high cholesterol:  atorvastatin, fluvastatin, lovastatin, pravastatin, simvastatin
  26. Antifungals:  itraconazole, voriconazole, griseofulvin / Amphotericin B, ketoconazole, sertaconazole, terbinafine, voriconazole
  27. Para-aminobenzoic acid (PABA) taken by mouth for dermatomyositis, morphea, pemphigus and vitiligo.
  28. Medications to treat leprosy:  Clofazimine (Lamprene), Dapsone
  29. Medications to treat hyperthyroidism:  propylthiouracil, methimazole
  30. Allergy medications / antihistamines: promethazine, cetirizine
  31. Medications used to treat tuberculosis:  rifabutin and rifapentine (Priftin)
  32. Nausea & Vomiting: metoclopramide, prochlorperazine
  33. Immunosuppressive medications:  Azathioprine, Cyclosporine
  34. Topical medications:  aminolevulinic acid, carmustine (BCNU), bergamot, bimatoprost (Latisse), carteolol, chlorhexidine, imiquimod, latanoprost, nitrogen mustard, tretinoin, verteporfin
pharmacist working on a laptop at a desk, sitting next to packages of pills

Medications cause dark spots in people of every race. However, it is more frequent and more noticeable in people with dark skin. The good news is that - in most cases - once the drug is stopped, the dark spots start to fade. In some cases, the hyperpigmentation can last a long time. Sometimes it is permanent.

So if you notice dark spots forming after starting a new medication, call your doctor. He or she may be able to put you on a different medication. Make it a habit to wear sunscreen and avoid sun exposure. This is important because the dark spots you get from a medication, will get darker with sun exposure. Additionally, many of the drugs that cause hyperpigmentation also cause photosensitivity.

Unfortunately, dark spots and hyperpigmentation are difficult to treat because the melanocytes that produce dark pigment are influenced by so many things. The sun, estrogen, pregnancy, hormone treatments, cellular senescence (an old cell that no longer remembers how to function properly), and inflammation, are just a few. Learn more in our blog posts on Melasma and Melasma Treatment.

Thanks for reading!

Masterpiece Skin Restoration is your online resource for all things medical aesthetics, skincare, beauty, and wellness. We keep you up to date on leading edge technology and the services available to help you restore your natural beauty.

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References:

https://www.ncbi.nlm.nih.gov/pubmed/11705252  Drug-induced skin pigmentation. Epidemiology, diagnosis and treatment.

https://www.ncbi.nlm.nih.gov/pubmed/6268671  Drug- and heavy metal--induced hyperpigmentation.

https://www.dermnetnz.org/reactions/drug-pigmentation.html

https://emedicine.medscape.com/article/1069686-clinical#b1  Drug-Induced Pigmentation Clinical Presentation

https://www.dermatologytimes.com/modern-medicine-now/drug-induced-hyperpigmentation-may-warrant-change-therapy

https://www.merckmanuals.com/professional/dermatologic-disorders/pigmentation-disorders/hyperpigmentation

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4308410/  New antiepileptic medication linked to blue discoloration of the skin and eyes

Essentials in Dermatology, Venereology & Leprology. Author: Ramesh Bansal. Publisher: New Delhi: Jaypee Brothers Medical Publishers (P) Ltd., 2015 English: 1st Edition p. 276

https://www.medicinenet.com/sun-sensitive_drugs_photosensitivity_to_drugs/article.htm

https://www.dermnetnz.org/reactions/fixed-drug-eruption.html

https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/dermatology/drug-eruptions/

https://emedicine.medscape.com/article/814960-overview  Heavy Metal Toxicity

https://www.dermnetnz.org/topics/drug-induced-photosensitivity/

https://fpnotebook.com/Derm/Pharm/MdctnCsOfHyprpgmntn.htm

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3937508/  A case of zidovudine induced pigmentation on palms and soles

https://oti-oncologytraining.com/2017/06/19/hyperpigmentation-drug-causes-during-chemotherapy/

https://www.dermatalk.com/blogs/skin-disorders/medications-that-can-cause-skin-pigmentation/

https://www.medscape.com/viewarticle/496206_2  Doxycycline-Induced Photo-Onycholysis

Disclaimer:

The Information provided on our website is not medical advice and should not be viewed as such. By law, only a medical doctor can diagnose or give medical advice. As a registered nurse, my goal is to educate, so I provide information on skin care, skin care products, and skin care treatments. If you have any condition that concerns you, please see a medical doctor. While most skin conditions are benign, some – like melanoma – can be deadly. If there is any doubt, please, please consult your physician. Thank you!

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