TOPLINE:

A higher risk for hyperpigmentation was seen with doxycycline, minocycline, and hydrochlorothiazide than with other medications in a large data analysis.

METHODOLOGY:

• Researchers used TriNetX data from 105 healthcare organizations to assess the prevalence of hyperpigmentation among patients with at least two billing codes for general medical examinations during 2024-2025.
• Doxycycline, minocycline, phenytoin, carbamazepine, amitriptyline, and hydrochlorothiazide were matched 1:1 to alternative medication control cohorts (n = 3004-645,452).
• Propensity scores were used to account for demographics, socioeconomic factors, disease severity, and concomitant medications, and risk was calculated at 1, 3, and 5 years post-drug initiation.

TAKEAWAY:

• The general population showed a 1-year hyperpigmentation incidence of 1.1% and prevalence of 7.7%; peak incidence occurred at ages 65-69 years.
• Doxycycline and minocycline conferred a twofold increased risk for hyperpigmentation compared with erythromycin (risk ratios [RRs], 2.76 and 2.36, respectively) and cephalexin (RRs, 2.25 and 2.36, respectively) at 1 year.
• Carbamazepine raised the risk for hyperpigmentation more than valproate at all timepoints (RR, 1.74-2.07), but only at 5 years compared with levetiracetam (RR, 1.28).
• Hydrochlorothiazide was associated with a modestly increased risk for hyperpigmentation compared with amlodipine (RRs, 1.12-1.26) and lisinopril (RRs, 1.13-1.17) at all timepoints.

IN PRACTICE:

“These findings suggest that while approximately 8% of the general population has clinically significant hyperpigmentation, certain medications confer modest but measurable increased risk,” the authors of the study wrote. “Notably, within 1 year of drug initiation, doxycycline and minocycline were associated with more than twofold increased risk, hydrochlorothiazide with a 12%-13% increased risk, while phenytoin and amitriptyline showed no significant association,” they added.

SOURCE:

The study was led by Debby Cheng, Harvard Medical School, Boston. It was published online on September 29 in JAAD International.

LIMITATIONS:

The limitations included lack of information on medication dosage, adherence, and potential misdiagnoses, as well as the use of previously validated algorithms for identifying hyperpigmentation.

DISCLOSURES:

The study did not receive any funding. Two authors reported receiving honoraria, advisory fees, and consulting fees from hims and hers, AbbVie, Sun Pharma, Pfizer, Digital Diagnostics, Eli Lilly and Company, Equillium, ASLAN, Boehringer Ingelheim, Dermatheory, Olaplex, Legacy Healthcare, Pelage, Incyte Corporation, Castle Biosciences, Galderma, and Sanofi.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.