{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T19:31:07Z","timestamp":1790796667721,"version":"4.1.0"},"reference-count":15,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,11,4]]},"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:p>A 73-year-old man presented to the emergency department with lethargy and influenza-like symptoms. Incidentally, prominent blue sclera and blue-grey skin discolouration to the periorbital skin, pinnae, neck, upper and lower limbs, hands, feet, fingernails and toenails were noted. His general practitioner (GP) had previously ceased amiodarone, believing it to be the causative agent. A literature search confirms the side effects were likely due to minocycline, which the patient had been taking for 10 years. Long-term minocycline use is associated with scleral and skin hyperpigmentation, with no apparent adverse effect on ocular structure or function. The pigmentation may reverse with cessation of minocycline, or it may be permanent. Amiodarone may also cause skin hyperpigmentation, but scleral pigmentation is not a known association. This case report explores the side effect profiles of these two drugs, and highlights the potential for confusion regarding causative agents when used concurrently.<\/jats:p>","DOI":"10.1136\/bcr-2021-245508","type":"journal-article","created":{"date-parts":[[2021,11,18]],"date-time":"2021-11-18T11:40:38Z","timestamp":1637235638000},"page":"e245508","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Minocycline-induced blue sclera and skin hyperpigmentation"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3445-1398","authenticated-orcid":false,"given":"Stacey","family":"Law","sequence":"first","affiliation":[{"name":"Emergency Department, Central Coast Local Health District, Gosford, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,11,18]]},"reference":[{"key":"2025082623362877000_14.11.e245508.1","doi-asserted-by":"crossref","DOI":"10.1056\/NEJMicm1702031","article-title":"Scleral discoloration from minocycline treatment","volume":"378","author":"Arshad","year":"2018","journal-title":"N Engl J Med"},{"key":"2025082623362877000_14.11.e245508.2","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.idcr.2016.12.003","article-title":"Diffuse skin hyperpigmentation associated with chronic minocycline use in a patient with prosthetic joint infection","volume":"7","author":"Berbari","year":"2017","journal-title":"IDCases"},{"key":"2025082623362877000_14.11.e245508.3","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2230.1985.tb00600.x"},{"key":"2025082623362877000_14.11.e245508.4","doi-asserted-by":"publisher","DOI":"10.2165\/00002018-199818060-00004"},{"key":"2025082623362877000_14.11.e245508.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0039-6257(97)00118-5"},{"key":"2025082623362877000_14.11.e245508.6","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1016\/S0161-6420(97)30204-8","article-title":"Minocycline-induced scleral pigmentation","volume":"104","author":"Fraunfelder","year":"1997","journal-title":"Ophthalmology"},{"key":"2025082623362877000_14.11.e245508.7","first-page":"627","article-title":"Minocycline","volume":"128","author":"Bernier","year":"2001","journal-title":"Ann Dermatol Venereol"},{"key":"2025082623362877000_14.11.e245508.8","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1038\/sj.bdj.2013.682","article-title":"Feeling blue? Minocycline-induced staining of the teeth, oral mucosa, sclerae and ears \u2013 a case report","volume":"215","author":"Johnston","year":"2013","journal-title":"Br Dent J"},{"key":"2025082623362877000_14.11.e245508.9","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9394(99)80156-1"},{"key":"2025082623362877000_14.11.e245508.10","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.136.9.1133"},{"key":"2025082623362877000_14.11.e245508.11","first-page":"939","article-title":"Black bones following long-term minocycline treatment","volume":"115","author":"Rumbak","year":"1991","journal-title":"Arch Pathol Lab Med"},{"key":"2025082623362877000_14.11.e245508.12","doi-asserted-by":"crossref","DOI":"10.3390\/ijms22073755","article-title":"Molecular and biochemical basis of minocycline-induced Hyperpigmentation\u2014the study on normal human melanocytes exposed to UVA and UVB radiation","volume":"22","author":"Rok","year":"2021","journal-title":"Int J Mol Sci"},{"key":"2025082623362877000_14.11.e245508.13","doi-asserted-by":"crossref","DOI":"10.3402\/jchimp.v4.24063","article-title":"Minocycline-induced hyperpigmentation","volume":"4","author":"Fiscus","year":"2014","journal-title":"J Community Hosp Intern Med Perspect"},{"key":"2025082623362877000_14.11.e245508.14","doi-asserted-by":"publisher","DOI":"10.12659\/MSM.890881"},{"key":"2025082623362877000_14.11.e245508.15","doi-asserted-by":"crossref","DOI":"10.4103\/0974-9233.154411","article-title":"Amiodarone-induced multiorgan toxicity with ocular findings on confocal microscopy","volume":"22","author":"Turk","year":"2015","journal-title":"Middle East Afr J Ophthalmol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-245508","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T06:36:40Z","timestamp":1756276600000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-245508"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11]]},"references-count":15,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,11,18]]},"published-print":{"date-parts":[[2021,11]]}},"alternative-id":["10.1136\/bcr-2021-245508"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-245508","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11]]}}}