Q: Which medicine may have cause this "bluish" discoloration of skin, known as "The blue man syndrome"?

Hint: Its a heart medicine and may cause brownish hyperpigmentation of skin as well.



A: Amiodarone

About 5% (some literature described upto 26%) of patients develop skin pigmentation from photosensitivity while on amiodarone treatment depending on dose and length of treatment. It is suggested that that UV exposure induces vasodilatation and increased diffusion of amiodarone and its metabolite desethylamiodarone in perivascular tissue, resulting in chronic accumulation of the drug. On histology, lipofuscin laden macrophages are seen.


Related previous pearls:

Why we call it Am-iod-arone!

Amiodarone Neurotoxicity!

Amiodarone - Digoxin interaction !



References: click to get abstract

1. The Blue Man - Amiodarone-Induced Skin Discoloration, Circulation. 2006;113:e63

2. Dose-dependent appearance and disappearance of amiodarone-induced skin pigmentation. Clin Cardiol 1996; 19: 592-4.

3. The pathogenesis of amiodarone-induced pigmentation and photosensitivity. Br J Dermatol 1984; 110: 451- 6.