Systemic pigmentation from tetracycline and minocycline therapy

To the Editor.— Minocycline hydrochloride is reported to be a safe and effective agent in the treatment of tetracycline-sensitive and tetracycline-resistant acne vulgaris.¹Long-term and high-dose administration of minocycline is known to cause blue or blue-black hyperpigmentation of the skin on the lower extremities, and atrophic scars.²When tetracyclines are given over prolonged periods, brown-black microscopic discoloration of the thyroid gland is seen.³Yellow bones have been noted following tetracycline therapy.⁴This report describes clinical and postmortem findings of a patient treated with high-dose, long-term tetracycline hydrochloride and minocycline. Report of a Case.— In January 1978 a 19-year-old man was first seen in the dermatology clinic of Keller Army Hospital, West Point, NY, with grade II-III acne (Pillsbury classification). He had not received prior therapy for acne. He was given 250 mg of tetracycline hydrochloride four times daily and a topical erythromycin base lotion. Six weeks