INTRODUCTION
Drug-induced cutaneous pigmentation has been described resulting from a number of medications,
but most commonly from minocycline and amiodarone.
1-28 Affected skin typically develops a slate-gray pigmentation.
Histopathologic evaluation of the pigment reveals brown
and black granules deposited extracellulary and intracellularly
within macrophages. The pigment is seen along blood vessels
and surrounding eccrine glands.2,6,10 Amiodarone and minocycline
pigmentation occur not only on the skin but in extra-cutaneous
sites including mucous membranes, eyes, bones, and
other tissues.14-17 Pigmentation on the skin from minocycline or
amiodarone typically occurs at sites of hypervascularity, such
as within facial photodamage, in areas of venous stasis, such
as the legs, and at sites of trauma or bruising.1,2,8-10,12,13 Druginduced
skin pigmentation resembles decorative or cosmetic
tattoos, both clinically and histopathologically, and thus it is no
surprise that lasers used to treat tattoos have also been used
to remove minocycline or amiodarone pigmentation.18-27 We
report here a case of facial amiodarone pigmentation treated
with the Q-switched neodymium:yttrium-aluminum-garnet
(Nd:YAG) laser.
CASE REPORT
The patient is a 57-year-old male with a one-year history of gray
facial pigmentation, which appeared during a course of amiodarone
therapy and persisted for two years following therapy,
when he presented to us for treatment. His past medical history
is significant for non-insulin dependent diabetes, hypertension, and coronary artery disease with placement of a pacemaker. His
medications at presentation were glipizide, digoxin, carvedilol,
and rosuvastatin calcium. He had taken amiodarone hydrochloride
400 mg/day for eight months, approximately three years
prior to his initial presentation at our office, and noticed his face
developing slate-gray pigmentation approximately 5-7 months
into his course of treatment. He stopped the amiodarone eight
months after initiating therapy, and presented for laser treatment
two years following his course of amiodarone. He presented
with gray pigmentation of his facial skin, accentuated in more
vascular regions of the central cheeks, nose, chin, and forehead
(Figure 1 a, c, and e).
Test spots were then performed using the Q-switched Nd:YAG laser
(MedLite C6, HOYA ConBio, Freemont, CA) at 4, 6 and 7 J/cm2
using a 4 mm-diameter spot. The 6 J/cm2 fluence was selected as
optimal based on the tissue reaction immediately following treatment,
and a small area of the right cheek was treated as a test area
using that fluence. The patient returned in four weeks, noting no
adverse effects with minimal swelling and erythema post-treatment
and clearance of pigment in the treated area. He was then
treated over his entire face using a fluence of 6 J/cm2 with a 4 mm-diameter
spot and the 1,064 nm wavelength with a repetition rate
of 2 Hz. He received a second treatment at the identical settings six
weeks after the first treatment. His third treatment was administered
six weeks after the second using a fluence of 3.1 J/cm2 with
a larger 6 mm-diameter spot for more even coverage, delivered
at a repetition rate of 2 Hz. The fourth, fifth, and sixth treatments
