Black Galactorrhea as a Consequence of Minocycline and Phenothiazine Therapy

Cutaneous staining associated with long-term minocycline hydrochloride administration was first brought to the attention of the medical community in 1978.¹,²Since then, numerous accounts of various pigmentation patterns have been reported. This hyperpigmentation occurs in two major forms,³each of which may represent distinct pathophysiologic processes. In the first form, dark localized blue-black macules are observed in areas of active or previous inflammatory activity.¹,⁴ The second form is characterized by a diffuse hyperpigmentation distant from the site of infection or inflammation. The color in this latter pattern has been described as occurring in various dark shades, including brown,⁵blue-brown,⁶blue-gray,⁷and blue-black.⁸In some cases, the areas of predilection have been demonstrated to be those most often exposed to sunlight,⁷,⁹especially the anterior lower extremities. A nonspecific generalized "muddy" hue of the skin may also accompany long-standing minocycline use.²,¹⁰,¹¹In addition,